南方医科大学学报

南方医科大学学报 ›› 2019, Vol. 39 ›› Issue (02): 235-.doi: 10.12122/j.issn.1673-4254.2019.02.17

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脂蛋白(a)与冠心病患者临床稳定性及冠状动脉狭窄程度的关系

马煜盛，饶甲环，龙洁旎，林立龙，刘季晨，郭志刚   

  • 出版日期:2019-02-20 发布日期:2019-02-20

Correlation of lipoprotein(a) with clinical stability and severity of coronary artery lesions in patients with coronary artery disease

  • Online:2019-02-20 Published:2019-02-20

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摘要： 目的探究血清脂蛋白（a）[Lp（a）]与冠状动脉粥样硬化性心脏病（CAD）及其冠状动脉狭窄程度的关系。方法回顾性收集 2013年1月~2016年12月在南方医院行冠脉造影的患者531例，按照Lp（a）浓度是否大于30 mg/dL分为高Lp（a）组（HLPA, n= 191）和低Lp（a）组（LLPA, n=340），根据冠脉造影结果判断是否罹患CAD；CAD患者根据临床稳定性分为稳定性心绞痛组（SAP 组）和急性冠脉综合征组（ACS组），比较两者及其冠脉狭窄程度与Lp（a）的关系。结果高Lp（a）组和低Lp（a）组间在年龄、性 别、体质量指数（BMI）、吸烟、高血压和糖尿病史无统计学差异（P>0.05），两组间有可比性。多因素Logisitic回归分析显示年龄、 性别、低密度脂蛋白胆固醇（LDL-C）和Lp（a）是入组人群患CAD的独立危险因素。Lp（a）升高，罹患CAD风险增高（OR=2.443， 95%CI：1.205~4.951，P=0.013）。且无论LDL-C 水平高低，高Lp（a）组较低Lp（a）组患CAD 的风险均更高（P=0.006 和P= 0.020）。在冠心病患者中，ACS组较SAP组Lp（a）水平更高（P<0.001）；高Lp（a）和低Lp（a）两组间高Gensini评分的患者分别占 17.3%和5.6%（P=0.026），其Gensini评分与Lp（a）呈线性关系（R=0.130, P=0.006）。结论Lp（a）是CAD的独立危险因素，高Lp （a）是CAD的残余风险；Lp（a）升高与冠心病临床稳定性及冠状动脉狭窄程度相关。

Abstract: Objective To analyze the correlation of lipoprotein(a) [Lp(a)] with the clinical stability and severity of coronary artery stenosis in patients with coronary artery disease (CAD). Methods A total of 531 patients undergoing coronary angiography in Nanfang Hospital between January, 2013 and December, 2016 were enrolled in this study. At the cutoff Lp(a) concentration of 300 mg/L, the patients were divided into high Lp(a) group (n=191) and low Lp(a) group (n=340). In each group, the patients with an established diagnosis of CAD based on coronary angiography findings were further divided into stable angina pectoris (SAP) group and acute coronary syndrome (ACS) group. The correlation between the severity of coronary artery stenosis and Lp(a) was evaluated. Results The patients in high and low Lp(a) groups showed no significant differences in age, gender, body mass index, smoking status, hypertension, or diabetes (P>0.05). Multivariate logistic regression analysis revealed that age, gender, and serum levels of low-density lipoprotein cholesterol (LDL-C) and Lp(a) were independent risk factors for CAD in these patients. A high Lp(a) level was associated with an increased risk of CAD (OR=2.443, 95%CI: 1.205-4.951, P=0.013). The patients with a high Lp(a) level were at a significantly higher risk of CAD than those with a low Lp(a) level irrespective of a low or high level of LDL-C (P=0.006 and 0.020). In the patients with CAD, the ACS group had a significantly higher Lp(a) level than the SAP group (P<0.001); the proportion of the patients with high Gensini scores was significantly greater in high Lp(a) group than in low Lp(a) group (17.3% vs 5.6%, P=0.026), and a linear relationship was found between Lp(a) level and Gensini score (R=0.130, P=0.006). Conclusion Serum level of Lp(a) is an independent risk factor for CAD, and an increased Lp(a) is the residual risk for CAD. In patients with CAD, a high Lp(a) level is associated with the clinical instability and severity of coronary artery stenosis.