社区人群脂蛋白(a)浓度的5年变化趋势及其影响因素研究

Study on the 5-year trend and influencing factors of lipoprotein (a) concentration in community-based population

目的探讨中国社区人群血循环脂蛋白(a)[Lp(a)]浓度随时间的变化趋势及其影响因素。方法本研究为前瞻性队列研究。入选中国多省市心血管病队列研究中参加2002年和2007年2次心血管病危险因素调查,并检测血清Lp(a)浓度的北京社区队列人群。根据基线(2002年)和复查(2007年)时的Lp(a)浓度,将研究对象分为<30.0 mg/dl(1 mg/dl=0.01 g/L)组,30.0~49.9 mg/dl组和≥50.0 mg/dl组。使用多因素logistic回归分析筛选与5年内Lp(a)绝对变化≥20.0 mg/dl或Lp(a)相对变化≥20%相关的因素。结果入选的1955名研究对象基线年龄为(56.5±8.0)岁,男性821人(42.0%)。基线Lp(a)浓度<30.0 mg/dl组,30.0~49.9 mg/dl组和≥50.0 mg/dl组分别有1657人(84.8%),184人(9.4%)和114人(5.8%)。5年间,基线Lp(a)浓度30.0~49.9 mg/dl组中有68人(37.0%)进展为Lp(a)≥50.0 mg/dl,102人(55.4%)仍维持在该水平。Lp(a)<30.0 mg/dl组(92.0%,1524/1657)或Lp(a)≥50.0 mg/dl组(94.7%,108/114)的更倾向于维持在各自水平。多因素logistic回归分析结果显示,除基线Lp(a)高浓度外,心血管病家族史、空腹血糖升高及口服降脂药物是Lp(a)变化的影响因素(P均<0.05)。结论边缘高Lp(a)浓度(30.0~49.9 mg/dl)的成年人可以考虑重复检测,尤其是有心血管病家族史、空腹血糖升高及口服他汀类药物的人群。

Objective To explore the trend and influencing factors of serum lipoprotein(a)(Lp(a))concentration over time in Chinese community populations.Methods This study is a prospective cohort study.The participants were enrolled from Chinese Multi-provincial Cohort Study-Beijing projects,completed the cardiovascular disease risk factor surveys in 2002 and 2007,and the serum Lp(a)concentration were measured.Based on the Lp(a)concentration at baseline(2002)and follow-up(2007),the participants were classified into subgroups of<30.0 mg/dl(1 mg/dl=0.01 g/L)group,30.0 to 49.9 mg/dl group,and≥50.0 mg/dl group,respectively.Multivariable logistic regression analysis was used to identify influencing factors associated with Lp(a)absolute change(≥20 mg/dl)and relative change(≥20%)within 5 years.Results Among 1955 participants with age of(56.5±8.0)years old and 821 male(42.0%)at baseline,there were 1657(84.8%),184(9.4%)and 114(5.8%)participants in Lp(a)<30.0 mg/dl group,30.0 to 49.9 mg/dl group and≥50.0 mg/dl group,respectively.Among the baseline Lp(a)concentration of 30.0-49.9 mg/dl group,68(37.0%)participants progressed to Lp(a)≥50.0 mg/dl after 5 years follow-up,and 102(55.4%)remained at this level.Participants with baseline Lp(a)<30.0 mg/dl(92%,1524/1657)or Lp(a)≥50.0 mg/dl(94.7%,108/114)tended to be maintained at their respective levels.The results of the multivariate logistic regression analysis showed that,in addition to the high level of baseline Lp(a)concentration,family history of cardiovascular disease,elevated fasting blood glucose and usage of oral lipid-lowering drugs were the influencing factors of Lp(a)changes over time(P<0.05).Conclusions Adults with borderline-high Lp(a)concentrations(30.0 to 49.9 mg/dl)could be considered for repeated testing,especially for those with a family history of cardiovascular disease,elevated fasting blood glucose and usage of statins.