早发型冠心病脂蛋白(a)升高与冠状动脉病变程度的相关性分析

Correlation Analysis of Elevated Lipoprotein(a)with the Severity of Coronary Artery Lesion in Premature Coronary Artery Disease

目的分析早发型冠心病(premature coronary artery disease,PCAD)中脂蛋白(a)[lipoprotein(a),Lp(a)]升高与冠状动脉病变程度的相关性。方法收集2020年3月~2021年3月于上海交通大学医学院附属新华医院行冠状动脉造影确诊为PCAD的457例患者的病例资料,包括一般临床资料、冠状动脉造影结果等。根据Gensini评分(gensini score,Gs)分为低Gs组(Gs<26分)和高Gs组(Gs≥26分),通过二元Logistic回归分析评价高Lp(a)与高Gs病变的相关性,将高Lp(a)人群分为高Lp(a)1组[Lp(a)≤50mg/dl]和高Lp(a)2组[Lp(a)>50mg/dl],建立多因素Logistic回归模型分析Lp(a)升高与高Gs病变发生风险的相关性。结果与低Gs组比较,高Gs组的吸烟者比例、体重指数、高Lp(a)比例更高,男性比例、他汀类药物应用比例、收缩压、舒张压更低(P<0.05)。校正影响因素后,多因素Logistic回归分析结果显示,高Lp(a)与冠状动脉高Gs病变的发生有相关性(OR=1.771,P<0.05)。与高Lp(a)1组比较,高Lp(a)2组的高密度脂蛋白更高(P<0.05),校正混杂因素后,多因素Logistic回归分析结果显示,高Lp(a)2组发生冠状动脉高Gs病变风险是1组的5.186倍(P<0.05)。结论PCAD中高Lp(a)与冠状动脉严重病变相关,随Lp(a)的升高,冠状动脉严重病变的发生风险增加。

Objective To analysis the correlation between elevated lipoprotein(a)[Lp(a)]and severity of coronary artery lesion in patients with premature coronary artery disease(PCAD).Methods The clinical data of 457 patients admitted to the Xinhua Hospital,Shanghai Jiao Tong University School of Medicine from March 2020 to May 2021 with PCAD were collected,including general clinical data and coronary angiography results.All patients were divided into lower Gs group(Gs score<26)and higher Gs group(Gs score≥26)according to Gensini score(Gs),and the binary Logistic regression was used to analyze the correlation between elevated Lp(a)and lesion with higher Gs.Patients with elevated Lp(a)were divided into elevated Lp(a)group 1[Lp(a)≤50mg/dl]and elevated Lp(a)group 2[Lp(a)>50mg/dl].Multivariate Logistic regression analysis was established to analyze the correlation between elevated Lp(a)and the risk of lesion with higher Gs.Results Compared with lower Gs group,the proportion of smokers,body mass index,and level of Lp(a)were higher than those in higher Gs group,while the the proportion of males and statin using,systolic blood pressure and diastolic blood pressure were lower than those in higher Gs group(P<0.05).Multivariate Logistic regression analysis showed that elevated Lp(a)was significantly correlated with the occurrence of higher Gs lesions after adjusting for the influencing factors(OR=1.771,P<0.05).Compared with the elevated Lp(a)group 1,the level of high-density lipoprotein was higher than that in elevated Lp(a)group 2(P<0.05).Multivariate Logistic regression analysis showed that the risk of coronary higher Gs lesion in the elevated Lp(a)group 2 was 5.186 times higher than that in the elevated Lp(a)group 1 after adjusting for the influencing factors(P<0.05).Conclusion Elevated Lp(a)is a risk factor for severe coronary artery lesion in patients with PCAD,which is positively correlated with level of Lp(a).