脂蛋白(a)中度升高患者罹患冠心病及其病变严重程度的影响因素研究  

Impact of moderate elevation in lipoprotein(a) on the incidence and severity of coronary heart disease

作　　者：郑文渊 曹嘉添 崔翰斌[1] ZHENG Wenyuan;CAO Jiatian;CUI Hanbin(Department of Cardiology,the First Affiliated Hospital of Ningbo University,Ningbo 315000,China;不详)

机构地区：[1]宁波大学附属第一医院心内科,315000 [2]复旦大学附属中山医院心内科

出　　处：《心电与循环》2024年第4期343-348,共6页Journal of Electrocardiology and Circulation

基　　金：浙江省动脉粥样硬化疾病精准医学研究重点实验室(2022E10026)。

摘　　要：目的 探讨脂蛋白(a)[Lp(a)]中度升高患者罹患冠心病及其病变严重程度的影响因素。方法 回顾性选取2017年1月至2019年7月复旦大学附属中山医院心内科收治的484例Lp(a)中度升高(在550~650 mg/L范围内)患者为研究对象。按照冠脉造影结果分为冠心病组298例,非冠心病组186例,比较两组患者临床资料,采用单因素及多因素logistic回归分析Lp(a)升高患者罹患冠心病的影响因素;采用Gensini评分评估冠心病组患者冠状动脉病变严重程度,采用有序单因素及多因素logistic回归分析Lp(a)升高的冠心病患者病变严重程度的影响因素。结果 冠心病组年龄、红细胞计数、血红蛋白、中性粒细胞计数、中性粒细胞与淋巴细胞比值、甘油三酯、糖化血红蛋白、空腹血糖、D-二聚体、超敏C反应蛋白以及男性、高血压、高脂血症、糖尿病、吸烟比例均高于非冠心病组,总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白(Apo)E均低于非冠心病组,差异均有统计学意义(均P<0.05)。性别(OR=0.338)、年龄(OR=1.041)、高血压(OR=1.817)、高脂血症(OR=2.288)、中性粒细胞与淋巴细胞比值(OR=1.231)、Apo E(OR=0.972)、糖化血红蛋白(OR=1.879)均是Lp(a)升高患者罹患冠心病的独立影响因素(均P<0.05)。冠心病患者高Gensini评分100例,中Gensini评分100例,低Gensini评分98例。高血压(OR=0.573)、Apo A1(OR=3.209)均是Lp(a)升高的冠心病患者病变严重程度的独立影响因素(均P<0.05)。结论 性别、年龄、高血压、高脂血症、中性粒细胞与淋巴细胞比值、Apo E、糖化血红蛋白均是Lp(a)中度升高患者罹患冠心病的独立影响因素,而高血压、Apo A1是冠心病病变严重程度的独立影响因素。Objective To investigate the factors influencing the incidence and severity of coronary heart disease(CHD) with moderately elevated lipoprotein(a) [Lp(a)]. Methods A retrospective study included 484 patients with moderately elevated Lp(a)(ranging from 550~650 mg/L) underwent coronary angiography in Zhongshan Hospital of Fudan University from January 2017 to July 2019. According to the results of coronary angiography, patients were divided into a CHD group(n=298) and a non-CHD group(n=186), and the clinical data of the two groups were compared.Univariate and multivariate logistic regression were used to analyze the influencing factors of CHD in patients with Lp(a)elevation. Gensini score was used to evaluate the severity of CHD in patients with CHD, and ordered univariate and multivariate logistic regression was used to analyze the influencing factors of the severity of CHD in patients with increased Lp(a). Results The proportion of male, age, hypertension, hyperlipidemia, diabetes, smoking, erythrocyte,hemoglobin, neutrophil, neutrophil/lymphocyte ratio, triglyceride, glycated hemoglobin and fasting blood glucose in CHD group were significantly higher than those in non-CHD group(all P <0.05). However, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol and apolipoprotein(Apo) E were significantly lower than those in the non-CHD group(all P<0.05). Gender(OR=0.338), age(OR=1.041), hypertension(OR=1.817), hyperlipidemia(OR=2.288), neutrophil to lymphocyte ratio(OR=1.231), Apo E(OR=0.972) and glycosylated hemoglobin(OR=0.187) were independent risk factors for coronary heart disease in patients with elevated Lp(a)(all P<0.05). There were 100 patients with high Gensini score, 100 patients with medium Gensini score, and 98 patients with low Gensini score. Hypertension(OR=0.573) and Apo A1(OR=3.209) were independent risk factors for the severity of CHD(both P<0.05). Conclusion Gender, age, hypertension, dyslipidemia, neutrophil-to-lymphocyte ratio, Apo E, and glycated hemoglobin a

关 键 词：脂蛋白(a) 冠心病 血脂异常 影响因素 

分 类 号：R541.4[医药卫生—心血管疾病]