脂蛋白(a)与冠脉病变严重程度的相关性分析

王玺; 刘子暖; 丁熠璞; 汪晶晶; 张威; 杨俊杰; 陈韵岱; 单冬凯

doi:10.3969/j.issn.2095-5227.2021.11.001

脂蛋白(a)与冠脉病变严重程度的相关性分析

Association between lipoprotein(a) and severity of coronary artery disease

摘要

摘要:
背景脂蛋白(a)lipoprotein(a)，Lp(a)是一种特殊的脂蛋白胆固醇，是导致冠脉粥样硬化的独立危险因素。
目的探讨Lp(a)与冠脉病变严重程度的相关性。
方法选择2016年1月- 2018年12月在解放军总医院第一医学中心因疑似冠心病(coronary artery disease，CAD)行冠脉计算机断层扫描血管成像(computed tomography angiography，CTA)检查的患者195例其中男性150例，患者平均年龄(56.21±10.12)岁，分析其Lp(a)水平与基于冠脉CTA的冠脉节段受累评分(segment involvement score，SIS)、冠脉节段狭窄评分(segment stenosis score，SSS)及Leiden评分的相关性。根据冠脉管腔直径狭窄率将纳入患者分为阻塞性CAD组(74例)和非阻塞性CAD组(121例)，进一步应用logistic回归分析阻塞性CAD的独立危险因素。
结果 Lp(a)水平与SIS(r=0.175，P=0.015)、SSS(r=0.172，P=0.016)、Leiden评分(r=0.187，P=0.009)均呈弱相关关系。多因素logistic回归分析显示，年龄(OR=1.048，95% CI：1.015 ~ 1.083，P=0.005)、血清葡萄糖(OR=1.461，95% CI：1.179 ~ 1.811，P=0.001)、Lp(a)(OR=2.407，95% CI：1.133 ~ 5.115，P=0.022)与阻塞性CAD独立关联。
结论 Lp(a)水平与冠脉病变严重程度呈弱相关，是阻塞性CAD的独立危险因素。

Abstract:
Background Lipoprotein(a) Lp(a) is a special kind of lipoprotein cholesterol which has been regarded as an independent risk factor for coronary atherosclerosis.
Objective To investigate the association between Lp(a) and severity of coronary artery disease.
Methods A total of 195 patients who accepted coronary computed tomography angiography (CCTA) scan for suspected coronary artery disease (CAD) from January 2016 to December 2018 were enrolled in this study. The correlation analysis was performed to detect the association between Lp(a) and CCTA-based anatomical quantitative scores, such as segment involvement score (SIS), segment stenosis score (SSS) and Leiden score. Patients were divided into obstructive CAD group (n=74) and non-obstructive CAD group (n=121) according to coronary luminal stenosis. Further Logistic regression analysis was conducted to determine the independent risk factors of obstructive CAD.
Results There were weak positive linear relationships between the Lp(a) levels and SIS (r=0.175, P=0.015), SSS (r=0.172, P=0.016), Leiden score (r=0.187, P=0.009). Age (OR=1.048, 95% CI: 1.015-1.083, P=0.005), fasting blood glucose (OR=1.461, 95% CI: 1.179-1.811, P=0.001) and Lp(a) (OR=2.407, 95% CI: 1.133-5.115, P=0.022) were independent risk factors for obstructive CAD after adjusting for traditional risk factors.
Conclusion Lp(a) levels have weak positive linear relationship with severity of coronary artery disease based on CCTA anatomical quantitative scores. Lp(a) is an independent risk factor for obstructive CAD.

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