脂蛋白(a)浓度变化与急性冠脉综合征患者预后的关系  

Relation between lipoprotein(a) variation and prognosis of patients with acute coronary syndrome

作　　者：欧艳秋[1] 易师欣 董豪坚[1] 余丹青[1] 周颖玲[1] 

机构地区：[1]广东省医学科学院广东省人民医院广东省心血管病研究所,广州510080

出　　处：《岭南心血管病杂志》2012年第4期337-341,363,共6页South China Journal of Cardiovascular Diseases

基　　金：广东省自然科学基金(项目编号:S2011010002091)

摘　　要：目的探讨血清脂蛋白(a)[lipoprotein(a),Lp(a)]浓度以及Lp(a)浓度的变化对经皮冠状动脉介入(percutaneouscoronary intervention,PCI)治疗完全血运重建后的急性冠脉综合征(acute coronary syndrome,ACS)患者预后的影响。方法选取240例因ACS行冠状动脉支架植入术并予常规药物治疗的患者,临床随访一年。检测基线及随访半年时Lp(a)浓度,并收集传统的心血管危险因素以及主要心血管事件(major adverse cardiac events,MACE)的资料。通过多因素Logistic回归的方法评价血清Lp(a)浓度的变化(基线水平至随访半年的变化)是否与ACS患者预后相关。结果基线血清Lp(a)浓度与冠状动脉Gensini评分呈正相关(r=0.142,P=0.027),与糖尿病的发生(r=-0.182,P=0.005)以及三酰甘油浓度(r=-0.156,P=0.016)呈负相关。在MACE发生的患者中,Lp(a)浓度平均升高了50 mg/L,而在非MACE患者中平均下降了40 mg/L。单因素Logistic回归分析发现基线Lp(a)浓度与MACE的发生无明显关系(OR=1.123,P=0.753),并筛选年龄(OR=1.03,P=0.060),Gensini评分(OR=1.010,P=0.015),原发性高血压(OR=1.696,P=0.069),糖尿病(OR=1.818,P=0.060)以及血清Lp(a)浓度变化的差值(OR=0.027,P=0.027)进入多因素Logistic逐步回归分析,发现Lp(a)浓度的变化(OR=3.119,95%CI=1.112～8.746,P=0.031)以及Gensini评分(OR=1.010,95%CI=1.002～1.018,P=0.016)可能是影响ACS预后的独立危险因素。结论基线血清Lp(a)浓度与ACS的预后无明显相关,与糖尿病的发生以及三酰甘油浓度呈负相关。在随访过程中,血清Lp(a)浓度的变化可能是ACS不良预后的独立危险因素。Objectives To assess the role of lipoprotein （a） [ Lp （a）] and Lp （a） variation in patients with acute coronary syndrome （ACS） with complete revascularization by percutaneous coronary intervention （PCT）. Methods A total of 240 ACS patients with complete revascularization by PCI were prospectively recruited and followed up for one year. Serum Lp （a） concentrations of baseline and half a year, traditional cardiovascular risk factors and major adverse cardiac events （MACE） were collected. Logistic regression analysis was used to assess whether Lp （a） variation （changes in serum Lp （a） concentrations of baseline and half a year） is a risk factor of ACS prognosis. Results Serum Lp （a） concentration of baseline was positively correlated to Gensini score （r=0.142,P=O.027）, but negatively correlated to incidence of diabetes mellitus （r=-0.182, P=0.005 ） and concentrations of triaeylglyeerol （TG） （r=-0.156, P=0.016）. Lp（a） concentration was averagely increased by 50 mg/L in patients with MACE, while averagely reduced by 40 mg/L in patients without MACE. Logistic regression analysis demonstrated that serum Lp （a） concentration of baseline had no significant association with incidence of MACE （OR =1.123, P=0.753）. Single-factor logistic regression analysis selected age （OR=l.03,P=O.060）, Gensini score （OR=1.010, P=0.015）, hypertension （OR=1.696, P= 0.069 ）, diabetes mellitus （ OR = 1.818, P=0.060 ） and Lp （ a ） variation （ OR =0.027, P=0.027 ） further into multivariate logistic Stepwise regression analysis, which implicated Lp （a） variation （ OR =3.119,95% CI= 1.112-8.746, P=0.031 ） and Gensini score （OR=1.010,95% CI=1.002-1.018,P=0.016） might be independent risk factors for ACS prognosis.Conclutions The present study demonstrates that serum Lp （a） concentration of baseline has no significant correlation to ACS prognosis, but is inversely associated with diabetes mellitus and TG concentrations. During the follow-u

关 键 词：冠状动脉疾病 脂蛋白(a) 预后 

分 类 号：R541.4[医药卫生—心血管疾病]