脂蛋白(a)与其他脂蛋白和载脂蛋白相关性研究

Study on the correlation of lipoprotein(a)with other serum lipoproteins and apolipoproteins

目的探讨冠心病患者血浆脂蛋白(a)与HDL-C、LDL-C、载脂蛋白(apo)A-Ⅰ、apoB的相关性,评价血脂异常与冠心病的相关性。方法选择因胸痛入院的患者1011例,经冠状动脉造影确诊为冠心病患者613例作为冠心病组,非冠心病患者398例作为对照组。测定脂蛋白(a)、apoA-Ⅰ、apoB、HDL-C和LDL-C,进行相关性分析,并计算apoB/apoA-Ⅰ比值。结果冠心病组的脂蛋白(a)、LDL-C及apoB水平较对照组明显升高(P=0.000);冠心病组脂蛋白(a)水平与LDL-C、apoB呈显著正相关(r=0.135、r=0.168,P<0.01),与HDL-C、apoA-Ⅰ无相关性。对照组脂蛋白(a)与LDL-C、apoB呈显著正相关(r=0.201、r=0.236,P<0.01),与HDL-C、apoA-Ⅰ无相关性。apoB/apoA-Ⅰ是诊断冠心病最显著的独立危险因素(OR=31.577,95% CI:8.324～11 9.788,P=0.000),其次为脂蛋白(a)(OR=19.446,95% CI:3.831～98.716,P=0.000)。结论脂蛋白(a)与LDL-C、apoB呈正相关,提示三者均为动脉粥样硬化的危险因素;apoB/apoA-Ⅰ和脂蛋白(a)为冠心病的独立危险因素。

Objective To explore the correlation between lipoprotein（a）[Lp（a）] and other lipo protein-related parameters including HDL-C, LDL-C,apoA-I and apoB,and to evaluate the relationship of dyslipidemia with coronary artery disease（CAD）. Methods 1011 patients who had complained chest pain were selected to receive the coronary angiography in our department. Of them,613 cases were confirmed to have coronary artery disease（CAD group） ,and other 398 cases without CAD served as a control group. All patients underwent individual detection of Lp（a）, apoA-I and apoB by means of immunoturbidimetry method,and of HDL-C and LDL-C by enzy- matic approach. The correlation analysis was carried out, and the apoB/apoA- I ratio was calcu- lated. Results The levels of Lp（a） ,LDL-C and apoB were significantly higher in CAD group than in control group （P = 0.000）. In CAD group,Lp（a） was demonstrated to have a positive correlation with LDL-C and apoB （r = 0. 135,r = 0. 168,P 〈 0.01）. In control group,Lp（a） was also demonstrated to have a positive correlation with LDL-C and apoB （r = 0. 201,r = 0. 236,P〈 0.01）.Both apoB/apoA-I （OR = 31. 577,95% CI. 8. 324-119. 788, P = 0.000） and Lp（a） （OR= 19. 446,95% CI. 3. 831-98. 716, P = 0. 000） were independent risk factors for diagnosing CAD. Conclusion The results indicate that in both groups,Lp（a） has a positive correlation with LDL-C and apoB,suggesting that all the three lipoproteins are risk factors for the atherosclerosis;apoB/apoA- I and Lp（a） are independent risk factors for coronary artery disease.