同型半胱氨酸和脂蛋白(a)同时升高对冠状动脉损伤的影响

The Effects of Simultaneous Increase of Homocysteine and Lipoprotein(a) on Coronary Artery Injury

目的探讨同型半胱氨酸和脂蛋白(a)同时升高对冠状动脉损伤程度和损伤范围的影响。方法连续入选2015年1月至2017年11月在马鞍山市人民医院接受冠脉造影及介入治疗的患者548例。根据冠脉造影、同型半胱氨酸和脂蛋白(a)检测结果,分析同型半胱氨酸和脂蛋白(a)水平与冠状动脉损伤的相关性,并评价同型半胱氨酸和脂蛋白(a)同时升高与单因素升高对冠状动脉损伤范围和损伤程度的影响。结果 (1)多因素回归分析显示同型半胱氨酸和脂蛋白(a)均为冠心病的独立危险因素,比值比分别为2.270(95%可信区间1.485～3.468)和2.150(95%可信区间1.408～3.279),P<0.05。(2)同型半胱氨酸和脂蛋白(a)同时升高患者冠脉3支病变更多(P<0.05),3支病变患者血浆同型半胱氨酸和脂蛋白(a)浓度较单支病变更高[(23.6±14.1)μmol/Lvs.(17.2±7.8)μmol/L和(373.2±117.0)mg/L vs.(306.9±165.9)mg/L,P<0.01]。(3)同型半胱氨酸和脂蛋白(a)同时升高患者的Modified Gensini评分更高(P<0.05)。结论血浆同型半胱氨酸和脂蛋白(a)水平与冠状动脉损伤具有正相关性,两者同时升高对冠状动脉损伤具有协同作用。

Objective The present study aimed to investigate the effect of homocysteine(Hcy)and lipoprotein(Lp)(a)on the degree of coronary artery injury and the extent of injury.Methods A total of 548 consecutive patients who receive coronary angiography and percutaneous coronary intervention in Ma’anshan People’s Hospital from January 2015 to November 2017 were enrolled.According to the results of coronary angiography,Hcy and Lp(a),we analyzed the correlation between Hcy and Lp(a)levels and coronary artery injury,evaluated the effect of elevated Hcy and Lp(a)on the extent of coronary artery injury and the degree of injury.Results①Multiple factor regression analysis showed that both Hcy and Lp(a)were independent risk factors for coronary heart disease(P<0.05).②The patients in group Hcy and Lp(a)increased simultaneously had more lesions of three coronary arteries than other groups(P<0.05).The concentration of plasma Hcy and Lp(a)in the three branches disease was higher than that of single branch disease(P<0.01).③The patients in group Hcy and Lp(a)increased simultaneously had significantly higher Modified Gensini Score compared with the other groups(P<0.05).Conclusion The level of plasma Hcy and Lp(a)is positively correlated with coronary artery injury.Both of them have synergistic effect for coronary artery injury.