高血压患者血清脂蛋白(a)浓度与颈动脉粥样硬化斑块的相关性研究

Relationship between the level of lipoprotein(a) and carotid atherosclerotic plaques in patients with high blood pressure

目的观察在低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)是否达标的高血压患者中血浆脂蛋白(a)[lipoprotein(a),Lp(a)]的浓度,及其与颈动脉粥样硬化斑块形成的相关性。方法入选高血压病史5年以上的高血压患者530例,按照LDL-C达标与否进行分层,再将每层按照有无颈动脉斑块进行分组,分为LDL-C达标有斑块组(A组)、LDL-C达标无斑块组(B组)、LDL-C未达标有斑块组(C组)和LDL-C未达标无斑块组(D组),观察各组Lp(a)的浓度。结果(1)LDL-C达标组患者的Lp(a)浓度低于LDL-C未达标组,其差异有统计学意义(P<0.01);(2)在LDL-C达标组中,A组患者Lp(a)浓度大于B组,但差异无统计学意义(P>0.05);在LDL-C未达标组中,C组患者Lp(a)浓度大于D组,差异具有统计学意义(P<0.01)。结论对于入院时LDL-C已达标的患者,基线Lp(a)浓度与颈动脉粥样硬化斑块发生无明显相关。然而,对于入院时LDL-C未达标的患者,基线Lp(a)浓度升高可能是颈动脉粥样硬化斑块形成的预测因素。

Objective To observe the serum level of lipoprotein（ a） in high blood pressure patients with low density lipopro-tein cholesterol （LDL-C） standards and its association with carotid atherosclerotic plaques. Methods Five hundred and thirty patients with history of hypertension for over 5 years were recruited for the study. They were stratified by depending on whether or not they reached the LDL-C standards. Then, by depending on whether there was presence of carotid plaques in each layer, they were divided into 4 groups： Group A with LDL-C standards and plaques, Group B with LDL-C standards but without plaques, Group C without LDL- C standards but with plaques, Group D without LDL-C standards but without plaques. Close observations were made on the levels of Lp （a） in each groups. Results （1 ） The Lp （ a） levels of the groups with LDL-C standards were lower than those of the groups without LDL-C standards. Statistical significance could be noticed when comparisons were made between them（P 〈0.01）. （2） In the group with LDL-C standards, the Lp （a） level in the patients of Group A was higher than that in the patients of Group B, but there was no statistical significance when comparisons were made between them（P 〉0. 05） . In the group without LDL-C standards, the Lp （ a） level in the patients of Group C was higher than that in the patients of Group D, with statistical significance（ P 〈0. 01） . Conclusion For the patients with LDL- C level reaching the required standards at the admission, baseline level of Lp （a） seemed to have no obvious corre-lation with carotid atherosclerotic plaques. However, for the patients without LDL-C level reaching the required standards at the admis-sion, elevated baseline LDL-C level might be a predicting factor in the formation of carotid atherosclerotic plaques.