2021 年第 11 期 第 16 卷

血清脂蛋白a与急性心肌梗死的相关性分析

Correlation between serum lipoprotein a and acute myocardial infarction

作者：侯云1张秀兰2

英文作者：Hou Yun1 Zhang Xiulan2

单位：1山西医科大学第二临床医学院，太原030001；2山西医科大学第二医院心内科，太原030001

英文单位：1The Second Clinical Medical College of Shanxi Medical University Taiyuan 030001 China; 2Department of Cardiology Second Hospital of Shanxi Medical University Taiyuan 030001 China

关键词：急性心肌梗死；脂蛋白a；冠状动脉病变

英文关键词：Acutemyocardialinfarction;Lipoproteina;Coronaryarterylesions

• 摘要：

• 目的 探讨血清脂蛋白a与急性心肌梗死（AMI）的相关性。方法 回顾性分析山西医科大学第二医院2017年2月至2019年2月收治的290例冠心病（冠状动脉粥样硬化性心脏病）患者的临床资料，其中AMI 200例（AMI组）、心绞痛90例（心绞痛组）。收集患者的性别、年龄、体重指数、吸烟史和合并症等一般资料，以及未经药物治疗前急性期的血脂水平和冠状动脉造影检查结果。比较AMI组和心绞痛组的一般资料、血脂水平和Gensini评分，分析AMI发病的危险因素以及AMI发生率与血清脂蛋白a水平的关系。根据脂蛋白a四分位数将AMI患者分为Q1组(脂蛋白a＜P25)、Q2组(脂蛋白a≥P25且＜P50)、Q3组(脂蛋白a≥P50且＜P75)、Q4组(脂蛋白a≥P75),比较不同四分位数组和不同冠状动脉病变支数组AMI患者的血脂水平和Gensini评分，分析AMI患者血清脂蛋白a水平与其他血脂指标和Gensini评分的相关性。结果 AMI组吸烟比例低于心绞痛组［39.5%（79/200）比52.2%（47/90）］，年龄、血清脂蛋白a水平和Gensini评分均高于心绞痛组［(62±11)岁比（61±9）岁，252.0（137.0，449.0）mg/L比151.0（81.8，324.8）mg/L,44.0（28.0，76.0）分比15.0（8.0，28.0）分］(均P＜0.05)。Logistic回归分析结果显示，血清脂蛋白a为AMI发病的危险因素（比值比=1.019，95%置信区间：1.007~1.032，P=0.003）。AMI发病率随血清脂蛋白a水平增加而升高(P＜0.001)。Q2组AMI患者血清LDL-C水平高于Q1组；Q3、Q4组 Gensini评分高于Q1组，且Q4组Gensini评分高于Q2组（均P＜0.05）。冠状动脉3支病变组AMI患者血清脂蛋白a水平高于单支病变组（P＜0.05）。AMI患者血清脂蛋白a水平与Gensini评分呈正相关(r＝0.401,P＜0.001)。结论 AMI组血清脂蛋白a水平高于心绞痛组，血清脂蛋白a为AMI发病的独立危险因素。在冠心病患者中，AMI发生率随血清脂蛋白a水平的增加而升高，AMI患者血清脂蛋白a水平与Gensini评分呈正相关。

• Objective To investigate the correlation between serum lipoprotein a and acute myocardial infarction (AMI). Methods  The clinical data of 290 patients with coronary atherosclerotic heart disease (CHD) admitted to Second Hospital of Shanxi Medical University from February 2017 to February 2019 were retrospectively analyzed, including 200 patients with AMI (AMI group) and 90 patients with angina pectoris (angina pectoris group). The general data of gender, age, body mass index, smoking history and complications, as well as the blood lipid level and coronary angiography result on acute stage before drug treatment were collected. The general information, blood lipid level and Gensini score of AMI group and angina pectoris group were compared. The risk factors of AMI and the relationship between AMI and serum lipoprotein a level were analyzed. According to the quartile of lipoprotein a, patients with AMI were divided into group Q1 (lipoprotein a <P25), group Q2 (lipoprotein a ≥P25 and <P50), group Q3 (lipoprotein a ≥P50 and <P75), and group Q4 (lipoprotein a ≥P75). The blood lipid level and Gensini score were compared among different quartile groups and different number of coronary artery lesions groups. The correlation of serum lipoprotein a level, other blood lipid indexes and Gensini score in patients with AMI was analyzed. Results The proportion of smoking in AMI group was lower than that in angina pectoris group ［39.5%(79/200) vs 52.2% (47/90)］; the age, serum lipoprotein a level and Gensini score in AMI group were higher than those in angina pectoris group ［(62±11) years vs (61±9) years， 252.0 (137.0,449.0) mg/L vs 151.0 (81.8,324.8) mg/L, 44.0(28.0, 76.0) vs 15.0(8.0,28.0)］ (all P<0.05). Logistic regression analysis showed that serum lipoprotein a was a risk factor for AMI (odds ratio=1.019, 95% confidence interval: 1.007-1.032, P=0.003). The incidence of AMI increased with the increase of serum lipoprotein a level (P<0.001). The serum low-density lipoprotein cholesterol level in group Q2 was higher than that in group Q1; the Gensini score of group Q3 and group Q4 were higher than that in group Q1, and the Gensini score in group Q4 was higher than that in group Q2 (all P<0.05). The level of serum lipoprotein a in three vessel lesions group was higher than that in single vessel lesion group (P<0.05). The serum lipoprotein a level was positively correlated with Gensini score (r=0.401, P<0.001). Conclusions  Serum lipoprotein a level in AMI group is higher than that in angina pectoris group. It is an independent risk factor for AMI. The incidence of AMI increases with the increase of serum lipoprotein a level and serum lipoprotein a level is positively correlated with Gensini score in patients with CHD.