心肌梗塞患者血清脂蛋白(a)水平和纤溶功能

Serum Lipoprotein(a) Level in Relation to Fibrinolytic Function in Patients with Myocardial Infarction

采用临床病例对照研究，分析56例心肌梗塞（MI）患者血清脂蛋白（a）（LP（a））水平和纤港功能。结果显示；MI组Lp（a）水平明显高于对照组（227mg／L与136mg／L，P＜0．001），多因素分析控制年龄、体重指数、腰臀比、血压、烟酒史、血脂质、纤维蛋白原、血糖和胰岛素后，MI组Lp（a）仍呈非常显著意义（P＝0．0037。MI组纤溶酶原活化物的抑制物（PAI－1）为11．23AU／ml，高于对照组（9.57AU／ml，P＜0.05），同样用多因素分析控制上述因素后，MI组PAI-1仍有显著意义。Lp（a）与PAI－1之间无明显相关性。多元逐步回归分析发现胰岛素与Lp（a）有关，体重指数和年龄与PAI－1有关。

A clinical case-control study to observe the level of serum lipoprotein(a) (Lp(a)) relating to fibrinolytic function by plasminogen activator inhibitor(PAI-1) activity and tissue plasminogen activator(TPA)activity in 56 cases of myocardial infarction (MI) against presumably healthy subjects as control was performed. The results showed that serum Lp(a) level wa. higher in MI group than that in control group(227mg/L vs 136mg/L,p<0. 001). Controlling for age,they mass index (BMI),waist hip ratio,blood pressure, smoking and alcoholic intake. blood lipids,glucose, irisulin and fibrinogen using covariance analysis, Lp (a)level in MI group was significantly higher as compared with that in control(P<0. 003). PAI-1 activity in MI group was 11. 23AU/ml,i,e,higher than that in control (9. 57AU/ml,P<0. 05) and also adjustment for factors mentioned above, the PAI-1 activity in MI group was still statistically significance in comparison with that in control (P=0. 036). TPA activity was slightly lower that in MI group than in control(P>0. 05). No significant correlations were observed between Lp(a) and PAI-1 or between Lp(a),PAI-1 and other cardiovascular risk factors. In multiple regression analysis,however,insulin was found to contribute to the variance of Lp(a) level,BMI and age were significantly related to PAI-1 activity. These data suggest that high level of Lp(a) and reduced fibrbolytic function by increase of PAI-1 activity are independently associated with myocardial infarction.