脂蛋白(a)浓度与稳定型心绞痛患者左主干斑块性质的相关性分析  

Association between Lipoprotein(a) and the characteristics of left main coronary artery plaque in patients with stable angina pectoris

作　　者：韩艳[1] 杨朝宽[1] 高传玉[1] 刘煜昊[1] 程江涛[1] 王宪沛[1] 王忠民[1] 吴秀娟[1] 徐成阳[1] Han Yan;Yang Chaokuan;Gao Chuanyu;Liu Yuhao;Cheng Jiangtao;Wang Xianpei;Wang Zhongmin;Wu Xiujuan;Xu Chengyang(Department of Cardiology,People’s Hospital of Henan Province,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院心内科,郑州450003

出　　处：《中华医学杂志》2019年第19期1490-1493,共4页National Medical Journal of China

基　　金：河南省科技攻关项目(172102310515).

摘　　要：目的:观察脂蛋白(a)[LP(a)]浓度与稳定型心绞痛患者左主干斑块组织构成成分的相关性。方法选择2010年6月至2016年10月在河南省人民医院行经皮冠脉支架植入术(PCI)的稳定型心绞痛患者102例,应用血管内超声虚拟组织学成像技术(IVUS-VH)评估其左主干斑块组织构成情况,并测定患者总胆固醇(TG)、三酰甘油(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、LP(a)水平。依据患者LP(a)浓度将其分为两组,LP(a)正常组(≤300mg/L)(n=67)以及LP(a)升高组(>300mg/L)(n=35),应用IVUS-VH评价两组患者左主干斑块的组织构成情况,并进一步评价患者LP(a)浓度与IVUS-VH评价的左主干斑块组织构成指标与上述血脂指标的相关性。结果LP(a)升高组冠脉左主干斑块的纤维脂质体积百分比显著高于LP(a)正常组[(25±5)%比(13±6)%,P<0.01],纤维组织体积百分比显著低于LP(a)正常组[(50±8)%比(61±9)%,P<0.01],且多因素线性回归分析显示:LP(a)浓度与左主干斑块纤维脂质组织体积百分比呈正相关(r=0.645,β=0.29,P<0.01),与斑块纤维组织体积百分比呈负相关(r=-0.467,β=-0.32,P<0.01),提示LP(a)水平与IVUS-VH评价的左主干斑块易损性相关。结论对于稳定型心绞痛患者来说,LP(a)水平与IVUS-VH评价的左主干斑块的纤维脂质组织体积百分比呈正相关,与纤维组织体积百分比呈负相关,LP(a)水平对冠状动脉左主干斑块易损性具有一定的预测价值。Objective To investigate the relationship between Lipoprotein (LP)(a) level and the characteristics of tissue components of left main coronary artery (LMCA) plaque. Methods A total of 102 patients with stable angina pectoris who underwent percutaneous coronary intervention (PCI) in the People’s Hospital of Henan Province from June 2010 to October 2016 were included. We performed intravascular ultrasound-virtual histology (IVUS-VH) to their LMCAs and evaluated the tissue characteristics, and the blood level of total cholesterol (TC), triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), ApoB, ApoA1, LP(a) were measured. According to the value of their LP(a) level they were divided into 2 groups (high LP(a) group (>300 mg/L)(n=35) and low LP(a) group (≤300 mg/L)(n=67)), then the relationship between the above lipid values and the tissue characteristics of the LMCA plaque in the patients were evaluated. Results Patients with a high LP(a) had a larger percentage of fibrolipid volume and a smaller percentage fibrous volume compared to patients with a normal LP(a)(25%±5% vs 13%±6%, P<0.01 and 50%±8% vs 61%±9%, P<0.01). Using multivariate linear regression analysis after adjustment for the above-mentioned confounding factors, LP(a) had a significantly positive correlation with fibrolipid volume percentage (r=0.645,β=0.29, P<0.01), and had a negative correlation with fibrous volume percentage (r=-0.467,β=-0.32,P<0.01), suggesting that the LP(a) was associated with the vulnerability of the LMCA plaque. Conclusion For the patients with stable angina pectoris, the LP(a) has a significantly positive correlation with the percentage of fibrolipid volume and a negative correlation with the percentage of fibrous volume, suggesting that the LP(a) could predict the vulnerability of the LMCA plaque.

关 键 词：脂蛋白(a) 血管内超声虚拟组织学成像术 左主干 易损斑块 

分 类 号：R541.4[医药卫生—心血管疾病] R445.1[医药卫生—内科学]