LDL-C、LP-a与Hcy联合检测在冠心病诊治中的应用

摘要

目的：探讨血清低密度脂蛋白胆固醇(LDL-C)、脂蛋白a (LP-a)、同型半胱氨酸(Hcy)联合检测在冠心病诊治中的价值。方法冠心病患者121例，分别为稳定性心绞痛(Stable angina，SAP)45例、不稳定性心绞痛(Unstable angina，UAP)38例、急性心肌梗死(Acute myocardial infarction，AMI）38例；健康对照组58例。测定项目所用方法：LDL-C为酶直接法、LP-a为免疫透射比浊法、Hcy为循环酶法。结果冠心病患者血清LDL-C、LP-a、Hcy浓度均明显高于健康对照组，差异有统计学意义(P<0.05)；冠心病各亚组间，UAP组LDL-C、LP-a浓度与SAP组比较，差异无统计学意义(P>0.05)，而Hcy高于SAP组，差异有统计学意义(P<0.05)；AMI组LDL-C、LP-a、Hcy浓度明显高于SAP组与UAP组，差异均有统计学意义(P<0.05)；冠心病各亚组内LDL-C、LP-a、Hcy三项联合检测的阳性率明显高于各单项检测的阳性率(P<0.05)。结论 LDL-C、LP-a、Hcy含量与冠心病的发生、发展及病情严重程度有关，三者联合检测可提高检测的阳性率，为冠心病的诊断、病情变化、治疗及预后评估提供依据。%Objective To explore the value of joint detection of serum low density lipoprotein cholesterol (LDL-C), Lipoprotein a (LP-a) and homocysteine (Hcy) in the diagnosis and treatment of coronary heart disease (CHD). Methods A total of 121 patients with coronary heart disease were enrolled in the study (CHD group), includ-ing 45 patients with stable angina pectoris (SAP, SAP subgroup), 38 patients with unstable angina pectoris (UAP, UAP subgroup), and 38 patients with acute myocardial infarction (AMI, AMI subgroup). Fifty-eight healthy participants were enrolled as the healthy control group. Enzyme direct method, immune turbidimetry, enzymatic cycling method were applied to detect LDL-C, LP-a, Hcy, respectively. Results In patients with coronary heart disease (CHD group), the concentrations of serum LDL-C, LP-a, Hcy were significantly higher than those in healthy control group, and the dif-ferences were statistically significant (P<0.05). Within each subgroup of the coronary heart disease, UAP subgroup showed no statistically significant difference in concentrations of LDL-C and LP-a compared with SAP group (P>0.05), but had higher levels of Hcy (P<0.05). AMI group had significantly higher concentrations of LDL-C, LP-a, Hcy compared with SAP group and UAP group (P<0.05). The positive rate of joint detection of LDL-C, LP-a, Hcy within each subgroup of coronary heart disease was significantly higher than that of each single detection (P<0.05). Conclusion The content of LDL-C, LP-a, Hcy is related with the occurrence, the development and the severity of cor-onary heart disease. Joint detection of the three parameters can improve the positive detection rate, as well as provide the basis for the diagnosis, changes of the disease condition, treatment and evaluation of prognosis of coronary artery lesion.