ACS合并糖尿病患者血清LP(a)水平与冠脉病变程度的关系研究

Relationship between serum LP(a) level and severity of coronary lesion in patients with acute coronary syndrome complicating diabetes

目的探讨急性冠脉综合征(ACS)合并糖尿病患者血清脂蛋白[LP(a)]水平与冠状动脉病变程度的关系。方法根据空腹血糖(FPG)水平将168例ACS患者分为三组:A组为单纯ACS组(FPG<6.1 mmol/L)52例、B组为ACS合并血糖升高组(6.1 mmol/L≤FPG<7.1 mmol/L)56例、C组为ACS合并糖尿病组(FPG≥7.1 mmol/L)58例,另选取50例正常健康体检者为对照组。分别测定各组收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血清LP(a)、C反应蛋白(CRP)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平,同时应用冠脉造影术测定ACS患者冠脉病变支数及病变程度(Gensini积分)。结果 A组、B组、C组SBP、DBP、TC、TG、LDL-C、LP(a)、CRP、CK、CK-MB水平高于对照组,而HDL-C水平低于对照组(P<0.05)。C组FPG、TG、LP(a)、CRP、CK、CK-MB显著高于A组和B组(P<0.05),而HDL-C水平低于A、B组(P<0.05),而B组LP(a)、CRP水平高于A组(P<0.05)。随着ACS患者冠脉病变支数增加,患者Gensini积分及血清LP(a)水平显著升高。Pearson相关分析显示,FPG、TG、LDL-C、LP(a)、CRP、CK、CK-MB与Gensini积分呈正相关(P<0.05)。经Logistic多因素分析显示,TG、LP(a)、CRP、CK是ACS合并糖尿病患者Gensimi评分的独立危险因素。结论 ACS合并糖尿病患者血清LP(a)水平显著高于ACS非糖尿病患者,LP(a)水平与ACS冠脉病变程度有关。

Objective To discuss the relationship between the level of serum lipoprotein [LP（a）] and severity of coronary lesion in patients with acute coronary syndrome（ACS） complicating diabetes. Methods ACS patients（n=168） were divided, according to the level of fasting plasma glucose（FPG）, into group A（single ACS, FPG6.1mmol/L, n=52）, group B（ACS complicating increased blood sugar, 6.1 mmol/L≤FPG7.1 mmol/L, n=56） and group C（ACS complicating diabetes, FPG≥7.1 mmol/L, n=58）, and other 50 health controls were chosen as control group. The levels of systolic blood pressure（SBP）, diastolic blood pressure（DBP）, total cholesterol（TC）, triglyceride（TG）, low-density lipoprotein cholesterol（LDL-C）, high density lipoprotein cholesterol（HDL-C）, LP（a）, C-reactive protein（CRP）, creatine kinase（CK） and creatine kinase MB（CK-MB） were detected respectively in all groups. At the same time the number of diseased coronary vessels and severity（Gensini score） were detected by using coronary angiography（CAG）. Results The levels of SBP, DBP, TC, TG, LDL-C, LP（a）, CRP, CK and CKMB were higher, and level of HDL-C was lower in group A, group B and group C than those in control group（P〈0.05）. The levels of FPG, TG, LP（a）, CRP, CK and CK-MB were significantly higher（P〈0.05）, and level of HDL-C was lower（P〈0.05） in group C than those in group A and group B. The levels of LP（a） and CRP were higher in group B than those in group A（P〈0.05）. As the increase of diseased coronary arteries, Gensini scores and LP（a） level increased significantly in ACS patients. Pearson correlation analysis showed that FPG, TG, LDL-C, LP（a）, CRP, CK and CK-MB were positively related to Gensini scores（P〈0.05）. Logistic multi-factor analysis showed that TG, LP（a）, CRP and CK were independent risk factors of Gensini scores for patients with ACS complication diabetes. Conclusion The level of serum LP（a） is significantly higher in patients with ACS complication diabetes than in those without complication diabetes, and LP（a） is related to the severity of coronary artery lesion of ACS.