脂蛋白(a)对低密度脂蛋白胆固醇达标的冠心病患者再发主要心血管事件的影响

Effect of lipoprotein(a) on incidence of subsequent major adverse cardiovascular events in coronary artery disease patients with desirable low-density lipoprotein cholesterol

目的 探讨脂蛋白（a）[lipoprotein（a）,Lp（a）]浓度对低密度脂蛋白胆固醇（low-density lipoprotein cholesterol,LDL-C）达标的冠状动脉粥样硬化性心脏病（冠心病）患者再发主要心血管事件（major adverse cardiovascular events,MACE）的影响.方法 入选接受经皮冠状动脉介入（percutaneous coronary intervention,PCI） 治疗的冠心病患者832例,其中男708例,女124例,年龄（62.2±10.8）岁,首先按患者基线LDL-C浓度是否达标进行分层,再将每层患者根据基线Lp（a）浓度分为Lp（a）正常亚组和Lp（a）升高亚组,观察终点为MACE.结果 在2年的随访中,共有151例（18.1％）患者发生MACE.对于入院时LDL-C浓度达标的患者,两组MACE发生率比较,差异无统计学意义（P＞0.05）;Lp（a）浓度升高并不是患者MACE发生的危险因素（P＞0.05）;但相对于Lp（a）正常的患者,入院时LDL-C浓度未达标且Lp（a）浓度升高患者的MACE发生率显著升高,差异有统计学意义（26.1％vs.16.6％,log-rank,P=0.023）.多因素Cox回归分析表明,Lp（a）浓度升高是患者MACE发生的独立预测因子（校正HR=2.23,95％ CI：1.13～4.39,P=0.020）.结论 对于入院时LDL-C浓度已达标的患者,Lp（a）浓度与患者再发MACE无明显相关.然而,对于入院时LDL-C浓度未达标的患者,Lp（a）浓度升高是冠心病患者再发MACE的独立预测因子.

Objectives To evaluate the effect of lipoprotein （a） [Lp （a）] concentration on the incidence of major adverse cardiovascular events （MACE） in coronary artery disease （CAD） patients with desirable low-density lipoprotein cholesterol （LDL-C） concentration.Methods Totally 832 CAD patients undergoing percutaneous coronary intervention （PCI） were sequentially recruited,including 708 males and 124 females,with an average age of （62.2± 10.8） years.Patients were firstly divided into desirable LDL-C stratum and non-desirable LDL-C stratum,then each stratum was divided into two subgroups according to Lp （a） concentration on admission：normal Lp （a） group [Lp （a） 〈30 mg/dL] and elevated Lp （a） subgroup [Lp（a） ≥30 mg/dL].The clinical endpoint was the incidence of MACE.Results During 2 years＇ follow-up,151 （18.1%） patients had MACE.In the desirable LDL-C concentration stratum,there was no significant intergroup difference in the incidence of MACE between normal Lp（a） group and elevated Lp（a） group （P〉0.05）.There was no association of elevated Lp （a） concentration with occurrence of MACE （P〉0.05）.In the non-desirable LDL-C concentration stratum,the MACE incidence of elevated Lp（a） group was significantly higher,compared with that of normal Lp （a） group （26.1% vs.16.6%,log-rank,P=0.023）.Multivariate Cox regression analysis showed a significant association between elevated Lp （a） concentration and occurrence of MACE （adjusted HR =2.23,95 % CI：1.13-4.39,P=0.020）.Conclusions For patients with desirable LDL-C concentration on admission,there is no significant association between Lp（a） concentration and subsequent MACE ; but for patients with non-desirable LDL-C concentration on admission,elevated Lp（a） concentration is an independent predictor for incidence of MACE.