血清脂蛋白（a）与冠心病的关系

摘要

目的：检测冠状动脉粥样硬化性心脏病（冠心病）患者血清脂蛋白（a）[Lp（a）]的变化，探讨其与冠心病的关系。方法回顾性分析2013年2月~2016年1月于南京医科大学第二附属医院心内科因胸痛入院行冠状动脉造影检查的患者419例，其中男性210例，女性209例。冠状动脉造影结果提示至少有1支冠状动脉直径减少≥50%归为冠心病组（189例）；造影结果提示冠状动脉直径减少＜50%为阴性者，作为对照组（230例）。冠心病组患者根据冠状动脉病变血管支数分为单支病变组（101例）、双支病变组（41例）和三支病变组（47例）。所有受试者采集血标本检测血清Lp（a）水平，同时测定总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FBG）水平等。结果与对照组相比，冠心病组患者年龄较大，糖尿病、高血压及高脂血症病史比例较高，吸烟比例较高，差异有统计学意义（P均＜0.01）。冠心病组血清TC、LDL-C、LP-a水平均显著高于对照组，差异有统计学意义（P均＜0.05）。除传统危险因素糖尿病和高脂血症病史、吸烟史、LDL-C外，TC（OR=2.531，95%CI：1.783~3.594），Lp（a）（OR=1.006，95%CI：1.004~1.008）是冠心病最显著的独立危险因素。冠心病三支病变组血清Lp（a）水平为（462.34±275.39）mmol/L，明显高于单支病变组（251.63±139.99）mmol/L、双支病变组（413.90±184.14）mmol/L；双支病变组血清Lp （a）水平明显高于单支病变组，差异有统计学意义（P均＜0.01）。结论脂蛋白（a）与冠心病以及冠状动脉病变严重程度相关。%Objective To detect the changes of serum lipoprotein-a (Lp-a) in patients with coronary heart disease (CHD), and discuss the relationship between Lp-a and CHD.Methods The patients (n=419, male 210 and female 209) hospitalized due to chest pain were chosen from the Department of Cardiology of Second Affiliated Hospital of Nanjing Medical University from Feb. 2013 to Jan. 2016. According to the outcomes of coronary angiograph (CAG), the patients were divided into CHD group (decrease of at least 1 coronary vessel diameter≥50%,n=189) and control group (decrease of coronary vessel diameter<50%,n=230). CHD group was divided again, according to numbers of diseased coronary vessels, into 1-vessel group (n=101), 2-vessel group (n=41) and 3-vessel group (n=47). The blood samples were collected from all patients for detecting the level of serum Lp-a, and at the same time the levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C) and fasting blood glucose (FBG) were detected.Results Compared with control group, the patients were older with higher percentages of history of diabetes, hypertension, hyperlipidemia and smoking in CHD group (all P<0.01). The levels of serum TC, LDL-C and LP-a were significantly higher in CHD group than those in control group (allP<0.05). Besides of traditional risk factors (history of diabetes, hyperlipidemia and smoking, and LDL-C), TC (OR=2.531, 95%CI: 1.783~3.594) and Lp-a (OR=1.006, 95%CI: 1.004~1.008) were the most significant independent risk factors of CHD. The level of serum LP-a was (462.34±275.39) mmol/L in 3-vessel group, which was significantly higher than that in 1-vessel group (251.63±139.99) mmol/L and 2-vessel group (413.90±184.14) mmol/L. The level of serum LP-a was higher in 2-vessel group than that in 1-vessel group (allP<0.01).Conclusion The level of serum LP-a is correlated to the severity of CHD and coronary artery lesions.