对血浆Lp(a)致动脉硬化作用的再评价—9540正常人群及4055病例对照结果分析  

Reassessment of Effects of Plasma Lipoprotein (a) on Atherogenesis-Analysis in 9540 Healthy Individuals , 4055 cases and controls

作　　者：于晖[1] 高岩[1] 娄可佳[1] 刘晓宁[1] 惠汝太 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院中德分子医学中心,北京市100037

出　　处：《中国分子心脏病学杂志》2005年第3期542-546,共5页Molecular Cardiology of China

基　　金：国家重点基础研究发展计划(973计划)基金资助项目(TG2000056901)

摘　　要：目的观察中国正常人群血浆Lp(a)的分布情况及特点,分析血浆Lp(a)水平的变化与心脑血管疾病危险性的关系,进一步证实血浆Lp(a)致动脉硬化的作用。方法采用ELISA的方法检测了9540正常人群的血浆Lp(a),分析了年龄、性别与L(a)水平之间的关系。检测了530例心肌梗死患者(冠脉造影证实)及229例对照(冠脉造影阴性)和1386例脑梗死患者(头颅CT或核磁共振检查证实)及1910例对照的血浆Lp(a),分析了血浆Lp(a)变化与疾病危险性的关系。结果(1)正常人群血浆Lp(a)呈偏态分布(P<0.01),中位数为19.6mg/dl,全距为209.7mg/dl。不同年龄、性别血浆Lp(a)水平分布情况,除大于50岁的女性以外,其余各组之间比较均无显著性差异。正常人的Lp(a)水平主要分布在11-20mg/dl的范围;(2)疾病组血浆Lp(a)水平明显高于对照组(P<0.001),Lp(a)>30mg/dl者,心肌梗死组占43.4%,脑梗死组占68.5%,与对照组比较有显著性差异(P<0.001),且随着Lp(a)浓度升高,心脑血管疾病的危险性有上升的趋势;(3)Logistic回归分析结果显示:Lp(a)>30%者发生心肌梗死的危险性增加(OR值为2.2,95%,CI:1.498-3.167,P<0.001)和脑梗死的危险性增加(OR值为2.1,95%,CI:1.767-2.489,P<0.001)。结论Lp(a)与动脉硬化密切相关,随着浓度升高,心脑血管疾病的危险性增加,它是一个独立的危险因子。Objective The purpose of this study was to investigate the distribution status of plasma Lipoprotein（a） [ Lp（a） ] in Chinese population and analyze the relationship of Lp（a） levels with cerebral and cardiovascular disease. Methods We examined the plasma level of Lp（a） by enzyme-linked immunosorbent assay in 9540 normal population; 530 patients with myocardial infarction（ documented angiographically） and 229 control（ angiographically normal） ;1386 patients with cerebral infarction （documented computed tomography or magnetic resonance imaging ） and 1910 controls. Traditional risk factors for cerebral and cardiovascular disease were investigated as well. Results （ 1 ） The plasma level of Lp（a） in normal population was non Gaussian distribution （P 〈0.05） ,median is 19.6mg/dl, interquartile range is 209.7 mg/dl. The range of Lp（a） levels in normal population is 11 - 20 mg/dl; （2） The plasma level of Lp（a） was significantly higher in patients with myocardial infarction and cerebral infarction than that in control （38.0 ±34. 7 vs 26.2 ±25.5 and 36.7 ± 27.3 vs 28.6 ± 20.5） （P 〈 0. 001 ）. Multivariate logistic regression analysis showed that Lp（a） was significantly associated with an increased risk of myocardial infarction （ OR = 2. 2, 95% CI ： 1. 498 ± 3. 167 ,P 〈 0. 001 ） and cerebral infarction （ OR = 2.1,95% CI： 1. 767-2.489, P 〈 0. 001 ） independent of other risk factors for myocardial infarction and cerebral infarction. Conclusion Lp （a） is significantly associated with Atherogenesis in Chinese population independent of other risk factors.

关 键 词：Lp(a) 动脉硬化 中国人群 

分 类 号：R543[医药卫生—心血管疾病]