血浆脂蛋白(a)浓度与青年人群冠心病关系的横断面研究

The Relationship Between Plasm Lipoprotein(a) Concentration and Coronary Heart Disease in Young Adults: a Cross-sectional Study

目的:探讨血浆脂蛋白(a)[Lp(a)]浓度与青年人群冠心病的相关性。方法:选取2018年3月至2019年2月期间在中国医学科学院阜外医院行冠状动脉造影术的1 093例青年患者作为研究对象(<45岁),按照冠状动脉造影结果分为冠心病组(n=906)和非冠心病组(n=187)。采用Gensini评分法评估冠心病组患者的冠状动脉病变严重程度,并将其分为三个亚组:高Gensini评分亚组(n=302)、中Gensini评分亚组(n=302)、低Gensini评分亚组(n=302)。收集所有研究对象的病史及相关临床与实验室检测指标,血浆Lp(a)检测采用免疫比浊法;分析基线血浆Lp(a)浓度与冠心病诊断及严重程度之间的关系。结果:冠心病组患者血浆Lp(a)浓度显著高于非冠心病组[13.46(6.58~28.91)mg/dl vs 8.39(5.06~19.31)mg/dl,P<0.001]。进一步分析显示,冠心病组男性、女性、高血压、无高血压、无糖尿病患者的血浆Lp(a)浓度均显著高于非冠心病组(P均<0.05)。多因素Logistic回归分析表明,logLp(a)水平升高为青年冠心病的独立危险因素(OR=2.898,95%CI:1.949~4.311,P<0.001)。在冠心病组患者中,高Gensini评分亚组的Lp(a)浓度明显高于中Gensini评分亚组及低Gensini评分亚组[18.07(9.22~40.29)mg/dl vs13.89(6.57~32.77)mg/dl、9.63(4.83~18.96)mg/dl,P均<0.001]。多元线性回归分析表明,较高logLp(a)水平与高Gensini评分显著相关(B=0.353,P<0.001)。结论:横断面观察提示,血浆Lp(a)浓度与青年人群冠心病的发生及病变严重程度相关,其结果有待更大样本前瞻性研究证实。

Objectives: To investigate the correlation between plasm lipoprotein(a) [Lp(a)] concentration and coronary atherosclerotic disease(CAD) in young adults.Methods: 1 093 young adults(<45 years old), who underwent coronary angiography in Fuwai Hospital from March 2018 to February 2019, were included in this study, subjects were divided into CAD group(n=906) and non-CAD group(n=187) according to coronary angiography results. The history of coronary artery disease and related clinical and laboratory parameters were collected. Lp(a) was detected by immunoturbidimetry. The severity of coronary artery disease was determined by Gensini score(GS) and divided into three subgroups: high GS group(n=302), middle GS group(n=302), low GS group(n=302). The relationship between baseline plasm Lp(a) concentration and the presence as well as severity of CAD was analyzed. Results: The level of plasm Lp(a) was significantly higher in CAD group than non-CAD group(13.46 [6.58~28.91] mg/dl vs 8.39 [5.06~19.31] mg/dl, P<0.001). The plasm Lp(a) levels of male, female, hypertension, non-hypertension, non-diabetes were all significantly higher in CAD group than non-CAD group(all P<0.05). Multivariate logistic regression analysis showed that elevated logLp(a) was an independent risk factor of CAD in young people(OR=2.898, 95%CI: 1.949-4.311, P<0.001). The Lp(a)concentration was significantly higher than that in the other two groups(P<0.001). Multivariate linear regression analysis showed that higher logLp(a) was significantly correlated with higher GS(B=0.353, P<0.001). Conclusions: This cross-sectional study suggestes that Lp(a) concentration is correlated with the presence and severity of CAD in young people. The results need to be confirmed by larger prospective studies.