老年冠心病患者脂代谢与凝血功能关系的临床分析

Clinical analysis of relationship between lipid metabolism and coagulation parameters in the elderly coronary heart disease

目的探讨血脂和凝血功能在老年冠心病患者发病中的作用及两者的关系。方法本文对220例冠心病患者和70例无冠状动脉病变对照者的血浆测定血浆脂蛋白a[LP(a)]、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、凝血酶—抗凝血酶Ⅲ复合物(TAT)、D-二聚体(D-D)、血浆纤维蛋白原(Fg)水平,根据冠状动脉造影结果将冠心病组分为单支和多支病变组,观察其与各指标之间的关系。结果老年冠心病组血脂水平和血浆Fg、TAT、D-D明显高于对照组,HDL-C低于对照组,且随着冠状动脉病变支数的增加,指标均明显升高(P<0.05)。FgLDL-C、LP(a)与冠状动脉病变程度密切相关(OR分别为1.17、1.10、和1.04、P<0.05)。结论Fg、LDL-C和LP(a)是冠心病发病的独立危险因子;血浆Fg、TAT和D-D浓度的监测对体内高凝状态和冠心病的预防具有重要意义。

Objective To investigate the relationship between plasma lipids and coagulation parameters and their roles in the etiology of coronary heart disease（CHD） in the elderly. Methods 220 cases of CHD and 70 cases of normal subjects were included in this study. Plasma lipoprotein（a）[LP（a）], total cholesterol, triglyceride, low density lipoprotein cholesterol（LDL- C） .high density lipoprotein cholesterol（HDL-C）,thrombin-antithrombin Ⅲ complex,D-dimer,fibrinogen were measured. CHD group were divided into single-vessel and multiple-vessel subgroup according to the results of angiography. Results Plasma lipids and levels of fibrinogen,thrombin-antithrombin Ⅲ ,D-dimer were significantly higher in patients with CHD than those in controls（ P 〈 0.05 ） ,and the more vessels involved,the higher in those parameters except for HDL-C. Multivariate regression model showed positive correlation between LDL-C, LP（a）, fobrinogen and coronary artery disease（OR= 1.17,1.10 and 1.04, P 〈0.05 ）. Conclusions LDL-C,LP（a） and Fibrinogen are independent risk factors of CHD. Surveillance of coagulation parameters is very important to hypercoagulative states, and has preventive effects for coronary heart diseases.