载脂蛋白（a）多态性与冠心病的关系

Apolipoprotein (a) polymorphism in relation to coronary heart disease in Chinese Han nationality

研究我国汉族人群载脂蛋白（ａ）［ａｐｏ（ａ）］多态性与冠心病（ＣＨＤ）的关系，同时探讨ａｐｏ（ａ）多态性对脂蛋白（ａ）［Ｌｐ（ａ）］和其他脂蛋白水平的影响。冠心病组共１０５例，其中有心绞痛症状并经冠状动脉造影证实有１支或１支以上冠状动脉主要分支狭窄≥７５％的患者２０例，陈旧性心肌梗塞患者８５例。正常对照组为无心血管病症状和体征的健康者。ａｐｏ（ａ）异构体多态表型的测定采用ＳＤＳ－聚丙烯酰胺凝胶电泳和Ｗｅｓｔｅｒｎ印迹技术。结果：ａｐｏ（ａ）低分子量表型（Ｂ、Ｓ１、Ｓ２）在ＣＨＤ组比对照组明显增多（３０．５％比１５．７％，Ｐ＜０．０５）；Ｌｐ（ａ）浓度ＣＨＤ组高于对照组（２５７±２２５ｍｇ／Ｌ比１４５±１５７ｍｇ／Ｌ，Ｐ＜０．００１）；Ｌｏｇｉｓｔｉｃ逐步回归分析表明，ａｐｏ（ａ）表型对ＣＨＤ具有独立判别意义，不受ＴＣ、ＬＤＬ－Ｃ及ＨＤＬ－Ｃ的影响，但其分子量与Ｌｐ（ａ）水平呈明显负相关（ｒ＝－０．７８）。由此可见，ａｐｏ（ａ）低分子量表型与高水平的Ｌｐ（ａ）密切相关，为我国汉族人群中ＣＨＤ的独立的遗传危险因素。

We investigated the association of apolipoprotein (a) [apo(a )]polymorphism with coronary heart disease in Chinese Han nationality.The effects of the apo(a) phenotypes on lipoprotein [LP (a)], total cholesterol (TC), high density lipoprotein cholesterol (HDL) , and triglyceride (TG) levels were also investigated.The CHD group consisted of 105 patients (85 were survivors from previous myocardial infarction and 20 had≥75% narrowing in at least one of the major coronary arteries found by coronary angiography). The control group included 102 healthy individuals who had no symptoms and clinical signs of cardiovascular diseases. Apo (a)phenotype was performed by SDS-polyacrylamide gel electrophoresis (PAGE) under reducing conditions followed by immunoblotting.Determination of (a) Lp(a)and other lipoproteins were also performed. The apo(a)low molecular weight phenotypes (B, S1, S2) were more frequent in the CHD patients than in the healthy individuals (30.5% vs 15.7%, P<0. 05). Lp(a) concentrations were significantly higher in the patients than in the controls (257± 225mg/L vs 145±157mg/L, P<0. 001). The results from stepwise logistic regression analysis indicated that apo (a) phenotype was a significant predictor of CHD, independent of TC , LDL-C and HDL-C. But apo(a) molecular weight was inversely related to Lp(a) levels.The apo(a) low molecular weight phenotypes associated with elevated Lp(a) levels was a primary genetic risk factor for CHD in Han Chinese.