冠心病伴T2DM患者血清Lp(a)水平变化与冠脉病变程度的关系探讨

The Relationship between Serum Lp(a)Level and The Degree of Coronary Artery Disease in Patients with Coronary Heart Disease and T2DM

目的探究冠心病(CHD)伴2型糖尿病(T2DM)患者血脂蛋白a[Lp(a)]水平与冠脉病变程度的关系。方法选取T2DM的患者123例,其中110例经冠状动脉造影(CAG)证实合并CHD,将其按冠脉狭窄程度分为中度狭窄组(30例)和重度狭窄组(80例),按冠脉病变范围分为单支病变组(25例)、双支病变组(55例)和多支病变组(30例)。另选取同期在本院就诊的正常冠脉志愿者30例作为对照组,分别测量各组血脂、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)以及Lp(a)水平。结果与对照组相比,CHD伴T2DM组患者的TG、Lp(a)水平均更高,但其HDL-C水平较对照组更低(P<0.05)。对照组、中度狭窄组、重度狭窄组的Lp(a)水平分别为(115.20±54.09)mg/L、(158.90±65.12)mg/L、(183.20±55.45)mg/L,重度狭窄组>中度狭窄组>对照组。对照组、单支组、双支组以及多支病变组的Lp(a)水平分别为(115.20±54.09)mg/L、(128.90±68.23)mg/L、(186.47±91.23)mg/L、(261.90±109.47)mg/L,多支病变组>双支病变组>单支病变组(P<0.05),但单支病变组与对照组的Lp(a)水平比较差异无统计学意义(P>0.05)。当Lp(a)>147.82mg/L时,其诊断CHD伴T2DM的AUC为0.821(0.747~0.881),灵敏度、特异度分别为77.27%和83.33%(P<0.05)。结论CHD伴T2DM患者Lp(a)水平随冠脉狭窄程度加重以及冠脉支数的增加而升高,临床可将Lp(a)作为冠脉病变程度情况判定的一个重要辅助指标以辅助临床的诊疗。

Objective To investigate the relationship between the level of lipid protein a[Lp(a)]and the degree of coronary artery disease in patients with coronary heart disease(CHD)and type 2 diabetes mellitus(T2DM).Method A total of 123 patients diagnosed with T2DM were selected,110 of whom were confirmed by coronary angiography(CAG)with CHD,and divided into moderate stenosis group(30 cases)and severe stenosis group(80 cases)according to the degree of coronary artery stenosis.According to the range of coronary artery lesions,the patients were divided into single-vessel lesion group(25 cases),double-vessel lesion group(55 cases)and multi-vessel lesion group(30 cases).In addition,30 volunteers with normal coronary artery artery treated in our hospital during the same period were selected as the control group,and the levels of blood lipid,apolipoprotein A1(ApoA1),Apolipoprotein B(ApoB)and Lp(a)in each group were measured.Results Compared with the control group,TG and Lp(a)levels were higher in the CHD with T2DM group,but HDL-C level was lower than that in the control group(P<0.05).The Lp(a)levels in control group,moderate stenosis group and severe stenosis group were(115.20±54.09)mg/L,(158.90±65.12)mg/L and(183.20±55.45)mg/L,with severe stenosis group>moderate stenosis group>control group.Lp(a)levels in control group,single arm group,double arm group and multi-arm lesion group were(115.20±54.09)mg/L,(128.90±68.23)mg/L,(186.47±91.23)mg/L,(261.90±109.47)mg/L.Multibranch lesion group>double-branch lesion group>single-branch lesion group(P<0.05),but there was no significant difference in Lp(a)level between single-branch lesion group and control group(P>0.05).When Lp(a)>147.82mg/L,the AUC of CHD with T2DM was 0.821(0.747-0.881),and the sensitivity and specificity were 77.27%and 83.33%,respectively(P<0.05).Conclusion The level of Lp(a)in CHD patients with T2DM increases with the severity of coronary artery stenosis and the increase of coronary artery number.Lp(a)can be used as an important auxiliary index to determine the severity of coronary artery lesions to assist clinical diagnosis and treatment.