吸烟与男性急性冠状动脉综合征患者高敏C反应蛋白、脂蛋白(a)及血脂水平的关系

Correlation analysis of relationship between smoking and high-sensitivity C-reactive protein,lipoprotein(a) and blood lipids levels in male patients with acute coronary syndrome

目的研究吸烟与男性急性冠状动脉综合征(ACS)患者血浆高敏C反应蛋白(hs-CRP)、脂蛋白(a)[LP(a)]和血脂水平的关系。方法纳入2016年1月至2017年1月中国人民解放军武汉总医院心内科收治的男性ACS患者181例,其中不稳定型心绞痛(UAP)66例、急性非ST段抬高型心肌梗死(NSTEMI)60例、急性ST段抬高型心肌梗死(STEMI)55例。收集吸烟、饮酒情况并测定血浆hs-CRP、LP(a)、血脂[三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]水平。分析不同吸烟情况下[非吸烟组(A组)、已戒烟组(B组)、吸烟组(C组)]男性ACS患者的血浆hs-CRP、LP(a)及血脂水平差异,并进行亚组分析。结果 (1)3组间年龄、体质指数(BMI)、饮酒情况、收缩压、空腹血糖、糖化血红蛋白水平差异均无统计学意义(均为P>0.05);3组间hs-CRP、HDL-C水平比较,差异均有统计学意义(均为P<0.001),而LP(a)、TG、TC和LDL-C水平比较,差异均无统计学意义(均为P>0.05);3组间冠状动脉造影及支架情况差异无统计学意义(均为P>0.05);(2)亚组分析显示,在NSTEMI和STEMI患者中,3组间的hs-CRP水平差异有统计学意义(P<0.05或P<0.01),且hs-CRP水平呈上升趋势,而在UAP患者中3组差异无统计学意义(均为P>0.05);在STEMI患者中,3组间的HDL-C水平差异有统计学意义(均为P<0.01),且HDL-C水平呈下降趋势,而在UAP和NSTEMI患者中差异均无统计学意义(均为P>0.05)。结论不同吸烟情况与男性ACS患者血浆hs-CRP、HDL-C水平密切相关,而与LP(a)、TG、TC、LDL-C水平无关,吸烟能导致hs-CRP水平升高,HDL-C水平降低,而戒烟能很大程度地改善hs-CRP、HDL-C水平。

Objective To study the relationship between smoking and plasma high-sensitivity Creactive protein,lipoprotein（ a） and blood lipid levels in male patients with acute coronary syndromes（ ACS）.Methods A total of 181 male ACS patients were enrolled in the Department of Cardiology,PLA Wuhan General Hospital from January 2016 to January 2017,including three subgroups [66 patients with unstable angina pectoris（ UAP）,60 patients with acute non-ST-elevation myocardial infarction（ NSTEMI）,and 55 patients with acute ST-elevation myocardial infarction（ STEMI） ]. History of smoking and alcohol consumption was collected; and levels of plasma hs-CRP,LP（ a）,lipids [triacylglycerol（ TG）,total cholesterol（ TC）,high density lipoprotein cholesterol（ HDL-C）,low density lipoprotein cholesterol（ LDL-C） ]were measured. The differences of hs-CRP,LP（ a）,serum lipids were compared among the non-smoking（ Group A）,quit-smoking（ Group B）,smoking（ Group C）,and ACS subgroups. Results（ 1） There was no significant difference in age,body mass index（ BMI）,alcohol consumption,systolic blood pressure,fasting blood glucose and glycosylated hemoglobin between group A,B and C（ all P〉0. 05）; the levels of hs-CRP,HDL-C in group A,B and C were significantly different（ all P〈0. 001）,but there were no significant difference in the levels of LP（ a）,TG,TC,LDL-C（ all P〈0. 05）; there was no significant difference between coronary angiography and stent in different smoking cases（ all P〉0. 05）.（ 2） Subgroup analysis showed that the levels of hs-CRP between the A,B,and C groups in NSTEMI and STEMI patients were statistically significant（ P〈0. 05 or P〈0. 01）,and the levels of hs-CRP were increasing in NSTEMI and STEMI patients（ all P〈0. 01）. The level of HDL-C in group A,B and C was statistically significant（ all P〈0. 01）,and the level of HDL-C was significantly different in patients with UAP（ P〉0. 05）. There was no significant difference between UAP and NSTEMI patients（ all P〉0. 05）. Conclusions Different smoking conditions are closely related to male plasma hs-CRP,HDL-C levels in patients with ACS,regardless of LP（ a）,TG,TC,LDL-C levels; smoking can cause elevated hs-CRP levels and decreased HDL-C levels,and smoking cessation can greatly improve hs-CRP and HDL-C levels.