2019 年第 1 期 第 14 卷

血浆脂蛋白a与急性冠状动脉综合征的相关性分析

Correlation between plasma lipoprotein(a) and acute coronary syndrome

作者：陈维君董茜陈永福吴其明

英文作者：

单位：100015首都医科大学附属北京地坛医院心内科

英文单位：

关键词：急性冠状动脉综合征；脂蛋白a；独立危险因素

英文关键词：

• 摘要：

• 【摘要】目的    探讨血浆脂蛋白a与急性冠状动脉综合征（ACS）的相关性。方法    回顾性选择2015年 5月至2016年10月首都医科大学附属北京地坛医院住院患者360例，其中冠状动脉造影显示正常或无有意义的狭窄者（冠状动脉主要血管狭窄＜50%）120例（对照组），初发ACS患者240例（观察组）。收集2组患者临床资料，对2组患者的性别、年龄、体重指数、吸烟史、高血压、2型糖尿病及脂代谢紊乱比例以及血脂水平进行比较，采用单因素及多因素Logistic回归分析ACS的相关危险因素。结果    观察组2型糖尿病、脂代谢紊乱和脂蛋白a≥300 mg/L比例以及总胆固醇、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白B水平均高于对照组，高密度脂蛋白胆固醇（HDL-C）、载脂蛋白A水平均低于对照组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析校正混杂因素后显示，大量吸烟、2型糖尿病、LDL-C、脂蛋白a≥300 mg/L均为ACS的独立危险因素（比值比=2.01、3.11、2.71、3.70,95%置信区间：1.13~3.58，1.70~5.69，1.88~3.91，1.99~6.90，均P＜0.05），HDL-C为ACS的保护性因素（比值比=0.17，95%置信区间：0.06~0.47，P＜0.05）。结论    脂蛋白a是ACS的独立危险因素，脂蛋白a≥300 mg/L显著增加ACS发病风险。

• 【Abstract】Objective    To investigate the correlation between plasma lipoprotein(a)［Lp(a)］ and acute coronary syndrome(ACS). Methods    Clinical data of 240 ACS patients (observation group) and 120 patients with main coronary artery stenosis＜50% (control group) in Beijing Ditan Hospital, Capital Medical University between May 2015 and October 2016 were retrospectively analyzed. Sex, age, body mass index, smoking, hypertension, diabetes, dyslipidemia and blood lipids were recorded. Risk factors of ACS were analyzed by single factor and multivariate Logistic regression. Results    Ratios of type 2 diabetes, dyslipidemia, elevated Lp(a) level［≥300 mg/L］ and levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), apolipoprotein(B) in observation group were significantly higher than those in control group; levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein (A) in observation group were significantly lower than those in control group（all P＜0.05）. Multivariate Logistic regression showed that smoking, type 2 diabetes, LDL-C and Lp (a) ≥300 mg/L were independent risk factors of ACS（odds ratio=2.01, 3.11, 2.71, 3.70; 95% confidence interval： 1.13-3.58， 1.70-5.69， 1.88-3.91， 1.99-6.90; P＜0.05）; HDL-C was a protective factor of ACS（odds ratio=0.17; 95% confidence interval： 0.06-0.47; P＜0.05）. Conclusion    Lp (a) is an independent risk factor of ACS; serum Lp(a)≥300 mg/L significantly increases the risk of ACS.