血清脂蛋白a水平与冠状动脉钙化的相关性分析

The association between serum lipoprotein(a)and coronary artery calcifi cation:a cohort study from China

目的探讨因胸痛接受冠状动脉CT检查的患者血清脂蛋白a[Lp(a)]水平与冠状动脉钙化(CAC)之间的相关性。方法共入选1085例因胸痛在阜外医院接受冠状动脉CT检查的患者,根据Agatston评分算法计算冠状动脉钙化评分(CACS)。所有入选患者均检测了血脂谱和Lp(a)水平。结果根据CACS进行分组,CACS>0分组(460例)患者血清Lp(a)水平明显高于CACS=0分组(625例)患者[23.60(14.73,44.56)mg/dl比12.73(5.56,31.10)mg/dl,P<0.001],差异有统计学意义。多元线性回归分析显示,血清Lp(a)浓度与CACS呈正相关(β=0.543,P<0.001)。曲线下面积(AUC)值显示血清Lp(a)水平在预测CACS方面具有正确的区分效力(AUC=0.71,95%CI 0.68~0.74,P<0.001)。Lp(a)的最佳截断值为10.51 mg/dl(敏感度为86.1%,特异度为51.7%)。结论在因胸痛接受冠状动脉CT检查的患者中,血清Lp(a)水平与CAC呈显著正相关。

Objective The present study aimed to explore the association between plasma Lp(a)levels and coronary artery calcifi cation(CAC)in Chinese patients with angina-like chest pain who underwent cardiac computed tomography(CT)scan.Methods A total of 1085 participants with angina-like chest pain who underwent cardiac CT scan in Fuwai Hospital were recruited in this study.The CACS was calculated according to the Agatston scoring algorithm.Traditional lipid profiles and Lp(a)were measured for all subjects.Results Patients with CACS>0 had signifi cantly higher plasma Lp(a)concentrations compared with those with CACS=0[23.60(14.73,44.56)mg/dl vs.12.73(5.56,31.10)mg/dl,P<0.001].Multivariable linear regression analysis suggested that the plasma Lp(a)concentration was positively associated with CACS(β=0.543,P<0.001).The area under the curve(AUC)for plasma Lp(a)levels in predicting CAC was 0.71(95%CI 0.68–0.74,P<0.001).The best cut-off of Lp(a)was 10.51 mg/dl with a sensitivity of 86.1%and specifi city of 51.7%.Conclusions The plama Lp(a)levels were signifi cantly associated with CAC in Chinese patients with angina-like chest pain who underwent cardiac CT scan.