血浆脂蛋白(a)与ST段抬高型心肌梗死患者冠状动脉病变严重程度的关系研究  

The relationship between plasma lipoprotein(a)and severity of coronary lesions in patients with acute ST-segment elevation myocardial infarction

作　　者：王莹 刘臣[1] 周鹏[1] 李健楠[1] 周金英[1] 赵霄潇 陈润真 宋莉[1] 赵汉军[2] 颜红兵[2] WANG Ying;LIU Chen;ZHOU Peng;LI Jian-nan;ZHOU Jin-ying;ZHAO Xiao-xiao;CHEN Run-zhen;SONG Li;ZHAO Han-jun;YAN Hong-bing(National Center for Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]国家心血管病中心北京协和医学院中国医学科学院阜外医院冠心病中心,北京100037 [2]国家心血管病中心,中国医学科学院阜外医院深圳医院心内科

出　　处：《中国介入心脏病学杂志》2020年第12期675-679,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨接受经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者血浆脂蛋白(a)[Lp(a)]浓度与冠状动脉病变严重程度的关系及冠状动脉病变严重程度对患者预后的影响。方法回顾性研究连续入选2012年1月至2017年12月在阜外医院接受急诊PCI的STEMI患者,采用Gensini评分法评估冠状动脉病变严重程度,并将患者分为两组,分析其临床特征及对预后的影响。生存分析采用Kaplan-Meier法。采用logistic单因素和多因素回归分析Lp(a)与冠状动脉病变严重程度之间的关系。结果共纳入2374例患者,年龄(58.9±11.9)岁,男性1900例(80.0%)。随访时间为561(385,1631)d。Gensini评分与全因死亡、心原性死亡及主要不良心脑血管事件(MACCE)均显著相关(均P<0.05)。Pearson相关分析示lg[Lp(a)]与Gensini评分存在正相关(r=0.311,P<0.001)。logistic多因素回归分析示Lp(a)水平是冠状动脉复杂程度的独立预测因子(OR 1.010,95%CI 1.007~1.014,P<0.001)。结论对于接受急诊PCI的STEMI患者,高Gensini评分提示不良预后。Lp(a)是冠状动脉病变复杂程度的独立预测因子。Objective To investigate the relationship between plasma lipoprotein(a)[Lp(a)] concentration and severity of coronary lesions in patients with acute ST-segment elevation myocardial infarction(STEMI) undergoing percutaneous coronary intervention(PCI) and the impact of coronary lesions severity on prognosis.Methods STEMI patients who underwent emergency PCI in Fuwai Hospital from January 2012 to December 2017 were enrolled.Gensini scoring was used to assess the severity of coronary lesions,and the patients were divided into 2 groups to analyze their clinical features and prognosis.Univariate and multivariate Logistic regression were used to analyze the relationship between Lp(a) and the severity of coronary lesions.Results A total of 2374 patients were enrolled,aged(58.9±11.9) years old,and 1900(80.0%) were males.The follow-up time was 561(385,1631) days.Gensini score was significantly associated with all-cause death,cardiogenic death and major adverse cardiovascular and cerebrovascular events(MACCE)(all P<0.05).Pearson correlation analysis showed that 1 g [Lp(a)] was positively correlated with Gensini score(r=0.311,P<0.001).Multivariate logistic regression analysis showed that Lp(a) level was an independent predictor of the severity of coronary lesions(OR1.010,95%CI 1.007-1.014,P<0.001).Conclusions For STEMI patients undergoing primary PCI,a high Gensini score suggests a poor prognosis.Lp(a) is an independent predictor of the complexity of coronary artery disease.

关 键 词：脂蛋白(a) ST段抬高型心肌梗死 经皮冠状动脉介入治疗 GENSINI评分 预后 

分 类 号：R543.3[医药卫生—心血管疾病]