冠心病合并2型糖尿病患者血浆脂蛋白a水平与冠脉病变的关系

摘要

探讨冠心病(CAD)合并2型糖尿病(DM)患者血浆脂蛋白(a)[LP(a)]水平与冠状动脉(冠脉)狭窄程度及范围之间的关系.方法:163例经冠状动脉造影(CAG)证实为CAD的2型DM患者按冠脉狭窄程度分中度(n=19)和重度(n=144)狭窄组,按病变范围分为单支(31例)、双支(48例)和多支(84例)病变组,54例无冠心病患者作为对照组,分别测量和比较各组Lp(a)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆同醇(LDL-C)、载脂蛋白A-I(ApoA-I)及载脂蛋白B(ApoB)水平.结果:中、重度狭窄组的Lp(a)水平高于对照组,中度狭窄组与重度狭窄组之间的Lp(a)水平差异无统计学意义.单支、双支、多支病变组Lp(a)水平高于对照组,多支病变组的Lp(a)水平高于单支、双支病变组,各组间TC、TG、HDL-C、LDL-C、ApoA-I、ApoB水平差异均无统计学意义.多元回归分析显示Lp(a)水平为冠脉狭窄程度和范围的危险因素.结论:Lp(a)水平可作为2型DM合并CAD患者冠脉病变严重性的评价指标之一.%Objective: To observe the correlation of lipoprotein (a)[Lp(a)] level and the extent, and severity of coronary artery lesions in coronary artery disease (CAD) patients with type 2 diabetes mellitua (DM). Methods: A total of 163 patients with angiographically documented CAD were divided into two groups including moderate stenosis group (n=19) and severe stenosis group (n=l 14) according to the severity of coronary artery lesion. The patients were divided into three groups including mono-vessel group (n=31), bi-vessel group (n=48) and multi-vessel group (n=84) according to the extent of coronary artery lesions. Fifty-four subjects without CAD were included in control group. The serum levels of Lp(a), total cholesterol (TC), tri-glycerides (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), apolipoprotein A-I (ApoA-I) and apolipoprotein B ApoB were measured and compared between groups. Results: The levels of Lp(a) were significantly higher in moderate stenosis group and severe stenosis group compared with that of control group. There was no significant difference in the level of Lp(a) between moderate stenosis group and severe stenosis group. The levels of Lp(a) were significantly higher in mono-vessel group, bi-vessel group and multi-vessel group than that of control group. And the level of Lp(a) was higher in multi-vessel group than that of mono-vessel group and bi-vessel group. There were no differences in levels of TC, TG, HDL-C, LDL-C, ApoA-I and ApoB between groups. Logistic regression analysis indicated that Lp(a) level was independently associated with the extent, and severity of coronary artery lesions in type 2 diabetic patients with CAD. Conclusion: The data suggest that Lp(a) level is helpful in determining the exient and severity of coronary artery lesions in type 2 diabetic patients with CAD.