脂蛋白a与急性心肌梗死相关性及冠状动脉病变程度及范围的研究
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摘要
目的探讨血浆脂蛋白a(Lp(a))水平与急性心肌梗死(AMI)患者冠状动脉(冠脉病变程度及病变范围相关性。方法选择2017年7月至2018年4月于华北理工大学附属医院心内科因胸痛入院,并行冠状动脉造影检查的患者206例,男性132例,女性74例。收集患者的临床资料,包括年龄、性别、吸烟史、饮酒史、体质指数、高血压病史、糖尿病病史,检测入院时血浆Lp(a)、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)水平。依据心肌梗死定义分为心绞痛组(AP组)(n=100)和AMI组(n=106),依据AMI冠脉造影结果AMI组分为单支血管病变组(n=8)、双支血管病变组(n=33)、三支血管病变组(n=65),依据病变程度和病变部位进一步计算冠状动脉Gensini评分。结果 AMI组血浆Lp(a)水平较AP组升高[(332.67±228.33)mg/L vs.(125.41±90.76)mg/L],差异有统计学意义(P<0.05);AMI组Lp(a)>300 mmol/L患者冠脉Gensini评分高于Lp(a)<300 mmol/L患者,差异有统计学意义(P<0.01);Logistic多因素分析显示排除了糖尿病史,高脂血症,饮酒等危险因素后,Lp(a)水平与AMI具有相关性(OR=1.011,P=0.000);血浆Lp(a)水平在AMI单支血管病变组,双支血管病变组和三支血管病变组未见差异;血浆LP(a)与Gensini评分呈线性正相关(r=0.392,P<0.01)。结论血浆Lp(a)水平、高血压、吸烟是AMI的危险因素。血浆Lp(a)与AMI冠脉病变程度呈正相关,与冠脉病变范围无关。
Objective To investigate the correlation among lipoprotein a [Lp(a)] and severity and scope of coronary artery lesions in patients with acute myocardial infarction(AMI). Methods The patients(n=206, male 132 and female 74) hospitalized due to chest pain and received coronary angiography(CAG) were chosen from Department of Cardiology in Affiliated Hospital of North China University of Science and Technology from July 2017 to Apr. 2018. The clinical data was collected from patients, including age, sex, smoking and drinking history, BMI, hypertension and diabetes history, and levels of plasma Lp(a), TC, TG, HDL-C and LDL-C. The patients were divided, according to definition of myocardial infarction, into angina pectoris group(AP group, n=100) and AMI group(n=106). AMI group was divided, according to CAG results, into 1-vessel lesion group(n=8), 2-vessel lesion group(n=33) and 3-vessel lesion group(n=65). Gensini scores were further calculated based on severity and scope of coronary artery lesions. Results The level of Lp(a) increased in AMI group compared with AP group [(332.67±228.33) mg/L vs.(125.41±90.76) mg/L, P<0.05]. Gensini scores were higher in patients with Lp(a)>300 mmol/L than those in patients with Lp(a)<300 mmol/L in AMI group(P<0.01). The results of multi-factor analysis showed that Lp(a) level was correlated to AMI(OR=1.011, P=0.000) after excluded diabetes history, hyperlipidemia and drinking. The level of plasma Lp(a) had no difference among 1-vessel lesion group, 2-vessel lesion group and 3-vessel lesion group. Lp(a) and Gensini scores showed a linear positive correlation(r=0.392, P<0.01). Conclusion The level of plasma Lp(a), hypertension and smoking are risk factors of AMI. Lp(a) is positively correlated to severity of coronary artery lesions and is not correlated to scope of coronary artery lesions of AMI.
Objective To investigate the correlation among lipoprotein a [Lp(a)] and severity and scope of coronary artery lesions in patients with acute myocardial infarction(AMI). Methods The patients(n=206, male 132 and female 74) hospitalized due to chest pain and received coronary angiography(CAG) were chosen from Department of Cardiology in Affiliated Hospital of North China University of Science and Technology from July 2017 to Apr. 2018. The clinical data was collected from patients, including age, sex, smoking and drinking history, BMI, hypertension and diabetes history, and levels of plasma Lp(a), TC, TG, HDL-C and LDL-C. The patients were divided, according to definition of myocardial infarction, into angina pectoris group(AP group, n=100) and AMI group(n=106). AMI group was divided, according to CAG results, into 1-vessel lesion group(n=8), 2-vessel lesion group(n=33) and 3-vessel lesion group(n=65). Gensini scores were further calculated based on severity and scope of coronary artery lesions. Results The level of Lp(a) increased in AMI group compared with AP group [(332.67±228.33) mg/L vs.(125.41±90.76) mg/L, P<0.05]. Gensini scores were higher in patients with Lp(a)>300 mmol/L than those in patients with Lp(a)<300 mmol/L in AMI group(P<0.01). The results of multi-factor analysis showed that Lp(a) level was correlated to AMI(OR=1.011, P=0.000) after excluded diabetes history, hyperlipidemia and drinking. The level of plasma Lp(a) had no difference among 1-vessel lesion group, 2-vessel lesion group and 3-vessel lesion group. Lp(a) and Gensini scores showed a linear positive correlation(r=0.392, P<0.01). Conclusion The level of plasma Lp(a), hypertension and smoking are risk factors of AMI. Lp(a) is positively correlated to severity of coronary artery lesions and is not correlated to scope of coronary artery lesions of AMI.
引文
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[22]Ojio S,Takatsu H,Tanaka T,et al.Considerable time from the onset of plaque rupture and/or thrombi until the onset of acute myocardial infarction in humans:coronary angiographic findings within 1 week before the onset of infarction[J].Circulation,2000,102(17):2063-9.
[2]Onat A,Hergen?§G,Ozhan H,et al.Lipoprotein(a)is associated with coronary heart disease independent of metabolic syndrome[J].Coron Artery Dis,2008,19(3):125-31.
[3]Yazici M,Demircan S,Durna K,et al.Lipoprotein(a)levels in patients with unstable angina and their relationship with atherothrombosis and myocardial damage[J].International Journal of Clinical Practice,2005,59(2):150-5.
[4]Cho JY,Jeong MH,Ahn Y,et al.High Lipoprotein(a)Levels are Associated With Long-Term Adverse Outcomes in Acute Myocardial Infarction Patients in High Killip Classes[J].Korean Circulation Journal,2010,40(10):491.
[5]Rae A,Hawkins R.Risk variables for coronary artery disease in Asian Indians[J].Diabetes Research&Clinical Practice,2001,87(3):267.
[6]Chien KL,Hsu HC,Su TC,et al.Lipoprotein(a)and cardiovascular disease in ethnic Chinese:the Chin-Shan Community Cardiovascular Cohort Study[J].Clinical Chemistry,2008,54(2):285-91.
[7]Tsurumi Y,Nagashima H,Ichikawa K,et al.Influence of plasma lipoprotein(a)levels on coronary vasomotor response to acetylcholine[J].Journal of the American College of Cardiology,1995,26(5):1242-50.
[8]王庆茹,刘仁光.心肌梗死第三次全球统一定义-2012 ESC/ACCF/AHA/WHF专家共识要点解读[J].中国心脏起搏与心电生理杂志,2013(3):269-70.
[9]Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease.Am J Cardiol 51:606[J].American Journal of Cardiology,1983,51(3):606.
[10]Berg K.A New Serum Type System in Man-The Ld System[J].Apmis,1965,59(3):369-82.
[11]Malaguarnera M,Vacante M,Russo C,et al.Lipoprotein(a)in Cardiovascular Diseases[J].Biomed Res Int,2012,2013(1):650989.
[12]Dahlén GH,Weinehall L,Stenlund H,et al.Lipoprotein(a)and cholesterol levels act synergistically and apolipoprotein A-I is protective for the incidence of primary acute myocardial infarction in middle-aged males.An incident case-control study from Sweden[J].Journal of Internal Medicine,1998,244(5):425-30.
[13]徐亚伟,李琦.脂蛋白a-冠脉疾病独立的危险因素[R].美国新奥尔良:第60届美国心脏病学学会,2011.
[14]Xue S,Green MA,LoGrasso PV,et al.Comparion of the effects of Apo(a)kringleⅣ-10 and plasminogen kringles on the interactions of lipoprotein(a)with regulatory molecules[J].Haemost,1999,81(3):428-35.
[15]Jin WK,Hong SS,Suh SY,et al.Relationship Between Lipoprotein(a)and Spontaneous Recanalization of Infarct-related Arteries in the Early Phase of Acute Myocardial Infarction[J].Clinical Cardiology,2008,31(5):211-6.
[16]Superko HR.Advanced lipoprotein testing and subfractionation are clinically useful[J].Circulation,2009,119(17):2383-95.
[17]Pellegrino M,Furmaniak-Kazmierczak E,LeBlanc JC,et al.The apolipoprotein(a)component of lipoprotein(a)stimulates actin stress fiber formation and loss of cell-cell contact in cultured endothelial cells[J].J Biol Chem,2004,279(8):6526-33.
[18]Motta M,Giugno I,Bosco S,et al.Serum lipoprotein(a)changes in acute myocardial infarction[J].Panminerva Medica,2001,43(2):77.
[19]Palabrica TM,Liu AC,Aronovitz MJ,et al.Antifibrinolytic activity of apolipoprotein(a)in vivo:human apolipoprotein(a)transgenic mice are resistant to tissue plasminogen activator-mediated thrombolysis[J].Nature Medicine,1995,1(3):256-9.
[20]Maher VMG,Brown BG,Marcovina SM,et al.Effects of Lowering Elevated LDL Cholesterol on the Cardiovascular Risk of Lipoprotein(a)[J].Jama,1995,274(22):1771-4.
[21]陶芳,孙胜玫,王玲.老年人无痛性急性心肌梗死55例临床分析[J].中华急诊医学杂志,1995(2):93-95.
[22]Ojio S,Takatsu H,Tanaka T,et al.Considerable time from the onset of plaque rupture and/or thrombi until the onset of acute myocardial infarction in humans:coronary angiographic findings within 1 week before the onset of infarction[J].Circulation,2000,102(17):2063-9.