急性冠脉综合征患者GRACE评分与血清脂蛋白a的相关研究

Correlation between serum lipoprotein （a） level and global registry of acute coronaryevent score in patients with acute coronary syndromes

目的：探讨急性冠脉综合征（ACS）患者血清Lp（a）水平与全球急性冠状动脉事件注册（GRACE）评分之间的关系,分析LP（a）水平对ACS患者住院期间发生主要不良心脏事件（MACE）及冠脉多支病变发生率的预测价值,为ACS患者进行早期的风险评估及进一步的临床治疗寻找新的评价指标.方法：连续入选ACS患者共195人,根据GRACE评分,分为低危组（45人）、 中危组（58人）、 高危组（92人）,所有患者均于入院24小时内行GRACE评分及测定血清脂蛋白（a）（LP（a））、 胆固醇（CHOL）、 甘油三酯（TG）、 低密度脂蛋白胆固醇（LDL-C）、 高密度脂蛋白胆固醇（HDL-C）水平,同时于住院期间完成冠状动脉造影检查.比较不同GRACE危险分层与LP（a）水平的关系及二者间的相关性,同时统计不同LP（a）水平与MACE事件发生率及冠脉多支病变发生率之间的关系.结果：①3组的LP（a）水平分别为（164.01±108.47）mg/L、（283.94±158.55）mg/L、（353.60±206.36）mg/L,3组间的LP（a）水平比较,差异有统计学意义（F=41.86,P〈0.01）.②将ACS患者的Lp（a）水平与其相对应的GRACE评分作双变量相关分析,结果显示两者呈正相关（r=0.862,P〈0.001）.③LP（a）小于300mg/L组及大于等于300mg/L组的MACE发生率分别为2.89%、11.90%,冠脉多支病变率分别为18.84%、69.05%,均有统计学差异（χ2=4.544,P〈0.05;χ2=44.984,P〈0.01）.结论：ACS患者的血清Lp（a）水平与GRACE评分呈正相关,对可作为对ACS患者进行早期危险分层的辅助手段;Lp（a）水平对ACS患者住院期间发生MACE的发生率及冠脉多支病变率有较好的临床预测价值.

Objective： To determine the correlation between global registry of acute coronary events （GRACE） risk score and serum lipoprotein （a） （LP （a）） levels, and to explore the clinical prognostic effect ofLp （a） for major adverse cardiac events （MACE） as well as incidence of multi-vessel coronary disease, and to search new evaluating indicator for early risk assessment and subsequent clinical treatment in patients with ACS. Methods： According to the GRACE score, 195 consecutive ACS patients, were divided into low risk group （45） , medium risk group （58） , high risk group （92） . All patients were subjected to risk assessment and stratification with GRACE risk score, and the laboratory data were collected within 24 hours after admission, including serum lipoprotein （a） （LP （a） cholesterol （CHOL） , three glycerol ester （TG） , low density lipoprotein cholesterol （LDL-C） , high density lipoprotein cholesterol （HDL-C） .The coronary angiograph （CAG） were completed during hospitalization. The relationship of different GRACE risk stratification and LP （a） level, and the correlation of the different LP （a） levels with the incidence of MACE events and multi-vessel coronary disease were analyzed. Results： （1） The LP （a） levels of the 3 groups were （164.01 ＋108.47） mg/L, （283.94±158.55） rag/L, （353.60±206.36） rag/L, the differences was statically significant （F=41.86, P〈0.01） . （2） Bivariate correlation analysis showed a positive correlation between Lp （a） level and GRACE score in patients with ACS （r=0.862, P〈0.001） . （3） The multi-vessel disease rate and MACE rate in the group with LP （a） level≥300 mg/L were 69.05% and 11.9%, being statistically higher than 18.84% and 2.89% in the group with LP （a） 〈300 mg/L （Xz=4.544, P〈0.05 ; X2=44.984, P〈0.01） . Conclusion： There was a positive correlation between Lp （a） level and GRACE score in patients with ACS, It was valuable for the early risk stratification of patients with ACS; Lp （a） has a better predictive value for MACE and multi-vessel disease in patients with ACS.