脂蛋白(a)与心肌梗死型早发冠状动脉粥样硬化性心脏病的关系

Association between Lipoprotein(a) and Clinical Type of Myocardial Infarction in Patients with Premature Coronary Artery Disease

目的 探讨血浆脂蛋白(a)[Lp(a)]水平与心肌梗死(MI)型早发冠状动脉粥样硬化性心脏病(pCAD)的关系,为pCAD患者进一步危险分层和指导治疗提供依据。方法 连续性纳入2014年1月至2018年11月确诊的pCAD患者1599例,其中MI患者344例(MI组),非MI患者1255例(非MI组),对包括血浆Lp(a)水平在内的血液学指标及其他传统心血管危险因素进行单因素和多因素logistic回归分析,分析血浆Lp(a)水平与MI型pCAD之间的关系。结果 调整血脂参数和其他传统心血管危险因素,多因素logistic回归分析结果显示,血浆Lp(a)水平是MI型pCAD的独立危险因素:血浆Lp(a)水平每升高1个标准差,MI型pCAD的风险增加32.2%(OR=1.322,95%CI:1.146-1.525,P <0.001);血浆Lp(a)> 30 mg/dl,MI型pCAD的风险增加74.2%(OR=1.742,95%CI:1.297-2.339,P <0.001)。吸烟史、纤维蛋白原、载脂蛋白A1水平也是MI型pCAD的独立危险因素(OR=2.107,95%CI:1.492-2.997,P <0.001;OR=1.180,95%CI:1.014-1.374,P <0.001;OR=0.337,95%CI:0.200-0.568,P <0.001)。结论 血浆Lp(a)水平是MI型pCAD的独立危险因素,提示血浆Lp(a)水平对pCAD患者进一步危险分层和治疗具有指导意义。

Objective To explore the relationship between plasma lipoprotein(a) [Lp(a)] level and clinical type of myocardial infarction(MI) in patients with premature coronary artery disease(pCAD),so as to provide basis for further risk stratification and guiding treatment in patients with pCAD.Methods From Jannuary 2014 to November 2018,1599 patients diagnosed with pCAD were consecutively enrolled.The patients were divided into MI group(n=344) and non MI group(n=1255).The hematological indexes including Lp(a) and other traditional cardiovascular risk factors were analyzed by univariate and multivariate logistic regression to explore Lp(a) level and clinical type of MI.Results After adjusting blood lipid parameters and traditional cardiovascular risk factors,multivariate logistic regression analysis showed that plasma Lp(a) level was independently correlated with MI in patients with pCAD.For every 1 standard deviation increase in Lp(a) level,the risk of clinical type of MI increased by 32.2%(OR=1.322,95%CI:1.146-1.525,P<0.001);Lp(a)>30 mg/dl,the risk of MI in patients with pCAD increased by 74.2%(OR =1.742,95%CI:1.297-2.339,P <0.001).Smoking,fibrinogen level and apolipoprotein A1 level were also independently correlated with MI(OR=2.107,95%CI:1.492-2.997,P<0.001;OR=1.180,95%CI:1.014-1.374,P<0.001;OR=0.337,95%CI:0.200-0.568,P<0.001).Conclusion Elevated Lp(a) levels are associated with the risk of clinical type of MI in patients with pCAD,which may contribute to further risk stratification for patients with pCAD and guiding their treatments.