sdLDL-C、sdLDL/LDL-C在慢性冠脉综合征中的研究进展

Research Progress of sdLDL-C and sdLDL/LDL-C in Chronic Coronary Syndrome

摘要: 慢性冠脉综合征(CCS)作为动脉粥样硬化性心血管疾病(atherosclerotic cardiovascular disease, ASCVD)的慢性阶段，其防治策略以血脂调控为核心环节。在血脂异常的管理原则方面，2023版指南重申LDL-C (低密度脂蛋白胆固醇)是防治ASCVD的首要干预靶点。LDL-C作为传统干预靶点已显著降低ASCVD事件发生率，但临床仍有可观的残余风险未获解决。最新研究提示，LDL-C中颗粒最小、密度最高的亚组分——小低密度脂蛋白(small dense LDL-C, sdLDL-C)——致动脉粥样硬化活性最为突出，且sdLDL-C与LDL-C的比值(sdLDL-C/LDL-C)对斑块负荷进展及不良心血管结局具有更精确的预测价值。鉴于上述证据，近年来针对sdLDL-C及其比值在CCS患者中的临床意义逐渐受到关注，本文拟对相关研究进展进行综述。

Abstract: Chronic coronary syndrome is a chronic stage of atherosclerotic cardiovascular disease, and its prevention and treatment strategy takes blood lipid regulation as the core link. In terms of the management principles of dyslipidemia, the 2023 edition of the guidelines reiterates that low-density lipoprotein cholesterol is the primary intervention target for the prevention and treatment of ASCVD. As a traditional intervention target, LDL-C has significantly reduced the incidence of ASCVD events, but there are still considerable residual risks in clinical practice that have not been resolved. Recent studies have suggested that small dense LDL-C (sdLDL-C), the sub-component with the smallest particle size and the highest density in LDL-C, has the most prominent atherogenic activity, and the ratio of sdLDL-C to total LDL-C (sdLDL-C/LDL-C) has a more accurate predictive value for plaque burden progression and adverse cardiovascular outcomes. In view of the above evidence, the clinical significance of sdLDL-C and its ratio in CCS patients has been paid more and more attention in recent years. This article intends to review the relevant research progress.