血清脂蛋白(a)在冠心病患者临床诊断中的应用价值  

Value of serum lipoprotein (a) in the clinical diagnosis of patients with coronary heart disease

作　　者：颜清[1] 穆润清[1] 戴锦娜[1] YAN Qing;MU Runqing;DAI Jinna(Department of Clinical Laboratory,First Affiliated Hospital of China Medical University,Shenyang,Liaoning 110001,China)

机构地区：[1]中国医科大学附属第一医院检验科,沈阳110001

出　　处：《检验医学与临床》2018年第16期2368-2370,共3页Laboratory Medicine and Clinic

基　　金：国家自然科学基金委员会青年科学基金资助项目(81501801)

摘　　要：目的探讨脂蛋白(a)[Lp(a)]在冠心病(CHD)患者临床诊断中的应用价值。方法选取CHD患者183例,非CHD患者160例。所有研究对象均于入院后第2天清晨采集空腹静脉血。对待检血清样品进行高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、三酰甘油(TG)、载脂蛋白A1(apoA-1)、载脂蛋白B(apoB)及Lp(a)检测。比较两组研究对象的血脂水平,采用Logistic回归分析CHD发病的影响因素;应用受试者工作特征曲线(ROC曲线)分析灵敏度及特异度。应用摩尔浓度(nmol/L)替代常规使用的质量浓度(mg/dL)来表达Lp(a)水平。结果 CHD组与非CHD组患者的HDL-C、TG、apoA-1比较差异无统计学意义(P>0.05);CHD组LDL-C、TC、apoB均明显低于非CHD组,而Lp(a)水平明显高于非CHD组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,Lp(a)诊断CHD的cut off值为30.8nmol/L,灵敏度与特异度分别为60.7%、71.2%。血清Lp(a)水平高于30.8nmol/L者CHD患病率明显高于Lp(a)水平低于30.8nmol/L者,差异有统计学意义(P<0.05)。结论 Lp(a)升高是发生CHD的危险因素,与血清中其他常用指标相比,Lp(a)具有更好的应用价值。Objective To investigate the clinical value of lipoprotein （a） [Lp（a） ] in coronary heart disea ses （CHD）. Methods In this study, 343 serum samples from 183 CHD patients and 160 non CHD patients were collected. Serum samples to be tested for high density lipoprotein cholesterol （HDL C） ,low density lipo protein cholesterol （LDL C）,total cholesterol （TC）,triglyceride （TG）,apolipoprotein A1 （apoA 1）,apoli poprotein B （apoB） and Lp（a） detection. Comparison of blood lipid levels between the two groups and logistic regression analysis was used to evaluate the factors influencing the onset of CHD. The receiver operating char acteristic （ROC） curve analysis was used to evaluate the sensitivity and specificity. The molar concentration （nmol/L） was used instead of the conventionally used mass concentration （mg/dL） to express the number of Lp（a） particles. Results The level of HDL C,TG and apoA 1 were no statistically significant difference be tween the CHD patients and non CHD patients （P〉0.05）. Compared with the non CHD patients,LDL C,TC and apoB was significantly lower than that in the CHD patients （P〈0.05）. While Lp（a） in CHD patients was much higher than that in non CHD patients and the difference was statistically significant （P〈0.05）. Using ROC curve analysis,we observed the cut off value of Lp（a） for detecting CHD was 30.8 nmol/L with a sensi tivity of 60. 7% and a specificity of 71. 2%. The incidence rate of CHD in high Lp（a） patients （≥ 30. 8 nmol/L） was significantly higher than that in low Lp （a） patients （〈 30. 8 nmol/L） and the difference was statistically significant （P〈0.05）. Conclusion Lp（a） is the risk factor for CHD,and have better application clinical value compared with other commonly used indicators in serum.

关 键 词：血脂 脂蛋白(a) 冠心病 受试者工作特征曲线 

分 类 号：R446[医药卫生—诊断学]