血清脂蛋白(a)与冠心病的关系  

Relationship between serum lipoprotein-a and coronary heart disease

作　　者：钱琦[1] 姜海[1] 郭守玉[1] 徐少华[1] 龙明智[1] QIAN Qi;JIANG Hai;GUO Shou-yu;XU Shao-hua;LONG Ming-zhi(Department of Cardiology, Second Affiliated Hospital, Nanjing Medical University, Nanjing 210011, China)

机构地区：[1]南京医科大学第二附属医院心内科,南京210011

出　　处：《中国循证心血管医学杂志》2016年第10期1201-1203,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的检测冠状动脉粥样硬化性心脏病（冠心病）患者血清脂蛋白（a）[Lp（a）]的变化，探讨其与冠心病的关系。方法回顾性分析2013年2月~2016年1月于南京医科大学第二附属医院心内科因胸痛入院行冠状动脉造影检查的患者419例，其中男性210例，女性209例。冠状动脉造影结果提示至少有1支冠状动脉直径减少≥50%归为冠心病组（189例）；造影结果提示冠状动脉直径减少＜50%为阴性者，作为对照组（230例）。冠心病组患者根据冠状动脉病变血管支数分为单支病变组（101例）、双支病变组（41例）和三支病变组（47例）。所有受试者采集血标本检测血清Lp（a）水平，同时测定总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FBG）水平等。结果与对照组相比，冠心病组患者年龄较大，糖尿病、高血压及高脂血症病史比例较高，吸烟比例较高，差异有统计学意义（P均＜0.01）。冠心病组血清TC、LDL-C、LP-a水平均显著高于对照组，差异有统计学意义（P均＜0.05）。除传统危险因素糖尿病和高脂血症病史、吸烟史、LDL-C外，TC（OR=2.531，95%CI：1.783~3.594），Lp（a）（OR=1.006，95%CI：1.004~1.008）是冠心病最显著的独立危险因素。冠心病三支病变组血清Lp（a）水平为（462.34±275.39）mmol/L，明显高于单支病变组（251.63±139.99）mmol/L、双支病变组（413.90±184.14）mmol/L；双支病变组血清Lp（a）水平明显高于单支病变组，差异有统计学意义（P均＜0.01）。结论脂蛋白（a）与冠心病以及冠状动脉病变严重程度相关。Objective To detect the changes of serum lipoprotein-a (Lp-a) in patients with coronary heartdisease (CHD), and discuss the relationship between Lp-a and CHD. Methods The patients (n=419, male 210 andfemale 209) hospitalized due to chest pain were chosen from the Department of Cardiology of Second Affiliated Hospitalof Nanjing Medical University from Feb. 2013 to Jan. 2016. According to the outcomes of coronary angiograph (CAG),the patients were divided into CHD group (decrease of at least 1 coronary vessel diameter≥50%, n=189) and controlgroup (decrease of coronary vessel diameter<50%, n=230). CHD group was divided again, according to numbers ofdiseased coronary vessels, into 1-vessel group (n=101), 2-vessel group (n=41) and 3-vessel group (n=47). The bloodsamples were collected from all patients for detecting the level of serum Lp-a, and at the same time the levels of totalcholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol(LDL-C) and fasting blood glucose (FBG) were detected. Results Compared with control group, the patients wereolder with higher percentages of history of diabetes, hypertension, hyperlipidemia and smoking in CHD group (allP<0.01). The levels of serum TC, LDL-C and LP-a were significantly higher in CHD group than those in control group(all P<0.05). Besides of traditional risk factors (history of diabetes, hyperlipidemia and smoking, and LDL-C), TC(OR=2.531, 95%CI: 1.783~3.594) and Lp-a (OR=1.006, 95%CI: 1.004~1.008) were the most significant independentrisk factors of CHD. The level of serum LP-a was (462.34±275.39) mmol/L in 3-vessel group, which was significantlyhigher than that in 1-vessel group (251.63±139.99) mmol/L and 2-vessel group (413.90±184.14) mmol/L. The levelof serum LP-a was higher in 2-vessel group than that in 1-vessel group (all P<0.01). Conclusion The level of serumLP-a is correlated to the severity of CHD and coronary artery lesions.

关 键 词：冠状动脉粥样硬化性心脏病 脂蛋白(a) 动脉粥样硬化 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]