他汀类药物应用对Lp(a)水平影响的相关性研究

A correlation study on the effect of statin application on Lp(a)levels

目的探讨他汀类药物的应用时间不同对血脂谱,尤其是对血浆脂蛋白(a)水平的影响,进一步明确使用他汀类药物后低密度脂蛋白胆固醇在不同水平时血浆脂蛋白(a)的变化情况。方法回顾性分析从2013年1月-2018年7月就诊于武警特色医学中心(包括门诊及住院)服用他汀类药物的冠心病患者(468例)及其随访的相关临床资料,选取最终符合纳入标准的患者327例。根据服药时间长短分为短期治疗组(服药3个月)113例、中期治疗组(服药6个月)111例和长期治疗组(服药12个月)103例,分析三组患者基线资料差异性,包括:年龄、性别、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、脂蛋白(a)、载脂蛋白A-I、载脂蛋白B、低密度脂蛋白胆固醇/高密度脂蛋白胆固醇、载脂蛋白A-I/载脂蛋白B。再分别比较不同时段治疗组患者脂蛋白(a)及相关血脂谱与自身基线相对照后的变化趋势。观察随着用药时间延长,LDL-C在不同降幅下Lp(a)的变化趋势。结果经短期(3个月)中等强度他汀治疗后,Lp(a)水平有下降趋势,但无统计学差异(P=0.076);经中期(6个月)中等强度他汀治疗后,Lp(a)水平明显下降(P=0.022);经长期(12个月)中等强度他汀治疗后,Lp(a)水平有下降趋势,但仍无统计学差异(P=0.454);研究发现当LDL-C降幅超过20%时,经短期治疗后,Lp(a)显著下降(P=0.025);经中期治疗后,Lp(a)显著下降(P=0.015);经长期治疗后,Lp(a)不再下降(P>0.015)。结论冠心病患者坚持服用中等强度他汀类药物治疗6个月左右时,Lp(a)水平能得到良好控制。中短期内接受中等强度他汀治疗后LDL-C控制良好的冠心病患者,其Lp(a)也能得到有效控制。

Objective To explore the effects of different application times of statins on blood lipid profile,especially on plasma lipoprotein(a)levels,and to further clarify the changes of low-density lipoprotein cholesterol at different levels and plasma lipoprotein(A)after the use of statins.Methods From January 2013 to July 2018,patients(468 patients)taking statins in the armed Police Medical Center(including outpatient and inpatient)and the relevant clinical data,and 327 patients met the inclusion criteria.According to the length of medication,it was divided into 113 cases in the short-term treatment group(3 months),111 cases in the mid-term treatment group(6 months)and 103 cases in the long-term treatment group(12 months),the baseline data of the three groups were analyzed,including:age,sex,total cholesterol,triglycerides,low density cholesterol,low density lipoprotein cholesterol,high-density lipoprotein cholesterol,lipoprotein(A),apolipoprotein A-I,apolipoprotein B,low density lipoprotein cholesterol/HDL cholesterol,apo lipoprotein A-I/apolipoprotein B.Then the trend of lipoprotein(a)and related lipid profile was compared with their baseline.The trend of Lp(a)in LDL-C was observed.Results After short-term(3 months)moderate intensity statin treatment,the level of Lp(a)showed a downward trend,but there was no statistical difference(P=0.076);after intermediate(6 months)moderate intensity statin treatment,the level of Lp(a)significantly decreased(P=0.022);after long-term(12 months)moderate intensity statin treatment,the level of Lp(a)showed a downward trend,but there was still no statistical difference(P=0.454);when the decrease in LDL-C exceeds 20%,Lp(a)significantly decreases after short-term treatment(P=0.025);after mid-term treatment,Lp(a)significantly decreased(P=0.015),after long-term treatment,Lp(a)no longer decreased(P>0.015).Conclusion Lp(a)levels are well controlled for moderate intensity statin therapy around 6 months.Lp(a)can also be effectively controlled in patients with good LDL-C control after moderate intensity statin treatment in the short to medium term.