冠心病患者体内脂蛋白（a）及纤溶系统水平的变化及意义

Lipoprotein（a） and fibrinolysis in patients with coronary heart disease

目的观察冠状动脉粥样硬化性心脏病（冠心病）患者体内脂蛋白（a）及纤溶系统水平的变化及其相关性。方法选择冠心病患者68例为冠心病组，包括稳定型心绞痛（SA）患者20例，不稳定型心绞痛（UA）患者48例，选择健康人20例为健康组作为对照进行研究，分别测定所有受试者血清脂蛋白（a）、纤溶酶原、血浆组织型纤溶酶原激活剂（t-PA）、纤溶酶原激活剂抑制物-1（PAI-1）含量，同时分析脂蛋白（a）与其他指标之间的相关性。结果冠心病组UA患者脂蛋白（a）、PAI-1水平较冠心病组SA患者和健康组明显升高，比较有统计学意义（均P〈0．01），而t—PA水平明显降低，比较有统计学意义（P〈0．01），但冠心病组SA患者t-PA水平与健康组比较无统计学意义（P〉0．05）；冠心病组sA患者体内脂蛋白（a）、PAI-1水平较健康组明显升高，比较有统计学意义（均P〈0．05）；而各组间纤溶酶原水平并无统计学意义（均P〉0．05）。冠心病患者脂蛋白（a）与PAI-1水平呈明显正相关（r=0．390，P〈0．01），与t-PA水平呈明显负相关（r=-0．387，P〈0．01），而与纤溶酶原水平无明显相关性（r=0．120，P〉0．05）。结论冠心病患者体内脂蛋白（a）水平明显升高，并且与纤溶系统的改变密切相关，可能在冠心病的病理过程中起重要作用。

Objective To observe the change of lipoprotein （a） level and fibrinolysis in patients with coronary heart disease（CHD）. Methods Sixty-eight CHD patients, including 48 unstabe angina pactories and 20 stable angina pectoris（SA） were enrolled. 20 normal cases were enrolled as control group. Levels of serum Lp（a）, plasminogen（ Pig）, plasma tissue plasminogen （t-PA） and plasminogen activator inhibitor-1 （ PAI-1 ） were respective- ly measured. Meanwhile the correlations between Lp（a） and others indexes were also analyzed. Results Compared with control group and SA patients, the levels of Lp （a）and PAI-1 significantly increased and t-PA decreased in patients with UA （ P 〈 0.01 ）. Compared with control group, the levels of Lp （a） and PAI-1 also significantly increased in patients with SA （ P 〈0. 05 ）. There were no significant differences of Pig levels among all groups. Levels of Lp（a）were positively related with PAI-1 （P 〈0.01 ）, negatively with t-PA （P 〈0.01 ） and no relation with Plg（P 〉 0.05）in patients with CHD. Conclusion The levels of Lp （a） in patients with CHD significantly increase, which is closely related to changes of fibrinolysis and may play an important role in the pathogenesis of CHD.