载脂蛋白E及脂蛋白(a)与冠心病的相关性分析  

Correlations of apolipoprotein E and lipoprotein (a) with coronary heart disease

作　　者：童明宏[1] 陶荣霞[1] 李盈[1] 王梓[2] 丁慧[1] 邓晨霞[1] 曹雅楠[1] 盛慧明[1] 

机构地区：[1]上海交通大学医学院附属同仁医院,上海200336 [2]蚌埠医学院,安徽蚌埠233000

出　　处：《检验医学》2017年第6期490-494,共5页Laboratory Medicine

基　　金：上海市长宁区科学技术委员会资助项目(CNKW2013J09)

摘　　要：目的研究冠心病(CHD)患者载脂蛋白E(apo E)及脂蛋白(a)[Lp(a)]的变化情况,探讨其与CHD病情严重程度的关系。方法选择经冠状动脉造影确诊的CHD患者229例,其中不稳定型心绞痛(UAP)73例、稳定型心绞痛(SAP)40例、急性心肌梗死(AMI)116例,以健康体检者102名作为正常对照组。检测所有对象血清apo E及Lp(a)水平,同时按照美国纽约心脏病协会(NYHA)心功能分级标准将CHD患者分为NYHAⅠ~Ⅳ级。CHD危险因素评估采用Logistic回归分析。结果在CHD患者中UAP组、SAP组、AMI组血清Lp(a)水平明显高于正常对照组(P<0.05),UAP组血清apo E水平明显高于正常对照组(P<0.05)。随着NYHA分级的升高,血清Lp(a)及apo E水平逐渐升高,但NYHAⅠ、Ⅱ级间血清apo E水平差异无统计学意义(P>0.05),NYHAⅢ、Ⅳ级间血清Lp(a)水平差异无统计学意义(P>0.05);其他各NYHA分级间血清Lp(a)及apo E水平差异均有统计学意义(P<0.05)。Logistic回归分析显示,apo E及Lp(a)均是CH D的独立危险因素[apo E:比值比(OR)=10.780,95%可信区间(CI)1.437~80.830;Lp(a):OR=4.930,95%CI 1.699~14.280]。结论 CHD患者存在脂类代谢紊乱,并与心功能下降有关。apo E及Lp(a)可能参与了CHD的病变过程。Objective To investigate the changes of apolipoprotein E（apo E） and lipoprotein（a）[Lp （a）] in patients with coronary heart disease（CHD）,and to investigate the correlations of apo E and Lp（a） with CHD severity.Methods A total of 229 CHD patients diagnosed by coronary arteriongraphy were enrolled. They were classified into 3 groups,unstable angina pectoris（UAP） group（73 cases）,stable angina pectoris（SAP） group（40 cases） and acute myocardial infarction（AMI） group（116 cases）. Totally,102 healthy subjects were enrolled as healthy control group. Serum apo E and Lp（a）levels were determined. CHD patients were classified into New York Heart Association（NYHA）Ⅰ-Ⅳ according to NYHA cardiac functional classification. CHD risk factor assessment was performed by Logistic regression analysis.Results The levels of Lp（a） in UAP,SAP and AMI groups were higher than those in healthy control group（P〈0.05）,and the level of apo E in UAP group was higher than that in healthy control group（P〈0.05）. The levels of Lp（a） and apo E were increased along with the increasing of CHD severity according to NYHA cardiac functional classification. However,the levels of apo E had no statistical significance between NYHA Ⅰ and NYHA Ⅱ（P〉0.05）,and the levels of Lp（a） showed no statistical significance between NYHA Ⅲ and NYHAⅣ（P〉0.05）. There was statistical significance for Lp（a） and apo E among other NYHA classification（P〈0.05）. Logistic regression analysis showed that apo E and Lp（a） were independent risk factors for CHD [for apo E,odds ratio（OR）= 10.780,95% confidence interval（CI） 1.437-80.830;for Lp（a）,OR=4.930,95%CI 1.699-14.280].Conclusions Lipid metabolic disorders are commonly seen in CHD patients with the decline of cardiac function. The parameters of apo E and Lp （a） may play roles in the pathogenesis of CHD.

关 键 词：脂蛋白(a) 动脉粥样硬化 冠心病 

分 类 号：R446.1[医药卫生—诊断学]