冠心病患者血浆脂蛋白a及相关载脂蛋白的表达及其意义

Analysis of Changes of Plasma Lipoprotein a and Related Apolipoproteins in Patients with Coro- nary Heart Disease

【目的】探讨脂蛋白a[Lp（A）]及相关载脂蛋ApoA-1、ApoB在冠心痛患者中表达变化及临床意义。【方法】回顾性分析2016年1月至2017年4月本院心内科收治的65例冠心病患者的临床资料（观察组），同时选择同期于本院进行体检的65例健康志愿者为对照组。从住院电子病历系统提取所有受试者临床资料及实验室检查结果，收集年龄、性别、是否患有高血压、糖尿病和高血脂等慢性疾病情况，比较两组血浆Lp（A）、ApoA-1、ApoB及ApoB／ApoA-1水平，通过受试者工作特征（ROC）曲线评估上述实验室检查指标对冠心病的预测价值，并采用Logistic回归分析相关参数与冠心病的相关性。【结果】观察组患者血清Lp（A）、ApoB、ApoB／ApoA-1水平显著高于对照组，差异具有统计学意义（P〈0．05）；观察组血清ApoA-1水平低于对照组，但差异无统计学意义（P〉0．05）。ROC曲线评估显示，ApoB／ApoA-1诊断冠心病的效能最高，其ROC曲线AUC（95％CI）为0．90（O．85～0．95），而Lp（A）与ApoB的诊断效能相当，其曲线下面积AUC（95％CI）分别为0．81（0．74～0．89）、0．78（0．70～0．86）。Lp（A）、ApoB、ApoB／ApoA-1最佳诊断临界值分别为156．4mg／L、O．83g／L、1．15。10gistic回归分析显示，Lp（A）〉156．4mg／L、ApoB〉0．83g／L、ApoB／ApoA-1〉1．15是冠心病的独立危险因素。【结论】冠心病患者Lp（A）、ApoB、ApoB／ApoA-1水平较高，是潜在的诊断冠心痛的临床指标，Lp（A）〉156．4mg／L、ApoB〉0．83g／L及ApoB／ApoA-1〉1．15是冠心病的独立危险因素。

[Objective]To investigate the changes and clinical significance of lipoprotein a [Lp （A）] and ApoA-1, ApoB in patients with coronary heart disease. [Methods] Sixty-five patients with coronary heart dis- ease treated in our hospital from January 2016 to April 2017 were retrospectively analyzed. Data （observation group）, while 65 healthy volunteers who were examined in our hospital at the same time were classified as control group. The clinical data and laboratory results of all subjects were collected from the inpatient electron- ic medical record system to collect age, sex, whether or not they were suffering from chronic diseases such as hypertension, diabetes and hyperlipidemia. The plasma levels of Lp（A）, ApoA-1, ApoB and ApoB/ApoA-1 were compared between the two groups. The predictive value of the above laboratory indexes for coronary heart disease （CHD） was evaluated by the （ROC） curve of the operating characteristics of the subjects. [Results] The serum Lp （A）, ApoB, ApoB/ ApoA-1 level in the observation group was significantly higher than that in the control group （ P 〈0.05）, and the serum ApoA-1 level in the observation group was lower than that in the control group, but the difference was not statistically significant （ P 〈0.05）. The evaluation of ROC curve showed that ApoB/ApoA-1 was the most effective in the diagnosis of coronary heart disease. The AUC （95% CI） of ROC curve was 0.81（0.74〈0.89）and 0.78（0.70〈0.86）. The optimal diagnostic critical value value of Lp（A） ,ApoB, ApoB/ApoA-1 was 156.4 rag/L, 0.83 g/L ,1.15. Logistic regression analysis showed that Lp （A）〈156.4 rag/L, ApoB〈0.83 g/L, ApoB/ApoA-l〈l.15 were independent risk factors of coronary heart disease.[Conclusions]The high level of Lp（A）, ApoB, ApoB/ApoA-1 in patients with coronary heart disease （CHD） is a potential clinical marker for the diagnosis of CHD. Lp（A）〈156.4 rag/L, ApoB〈0.83 g/L and ApoB/ApoA-l〈l.15 are independent risk factors for coronary heart disease.