C反应蛋白和脂蛋白a与冠状动脉狭窄程度的相关性研究

Correlation of lipoprotein a and C-reactive protein levels with the degree of coronary artery stenosis

关键词:  C-反应蛋白  脂蛋白a  急性冠脉综合征  Gensini评分

Key words:  C-reactive protein  lipoprotein a  acute coronary syndrome  Gensini score

摘要:

目的探讨不同炎症C反应蛋白（CRP）水平下Lp（a）与急性冠脉综合征（acute coronary syndrome, ACS）患者冠脉狭窄的相关性。 方法本研究共纳入429例ACS患者,采用高灵敏度比浊法和酶联免疫吸附法分别测定CRP和Lp（a）的表达水平,将CRP≥10mg/L定义为CRP+,CRP＜10mg/L定义为CRP-；Lp（a）≥300ng/mL定义为Lp（a）+,Lp（a）＜300ng/mL定义为Lp（a）-。所有纳入的患者根据检测结果分为4组,包括CRP-/Lp(a)-、CRP-/Lp(a)+、CRP+/Lp(a)-、CRP+/Lp(a)+；冠状动脉狭窄程度通过冠状动脉造影评估,使用Gensini评分计算狭窄严重程度；采用多变量Logistic回归模型分析CRP和Lp（a）水平联合与冠状动脉狭窄程度之间的关系。 结果年龄、吸烟、高血压病、糖尿病、Gensini评分四组存在显著差异（P＜0.05）,CRP-时,多因素线性回归分析模型分析发现年龄、吸烟以及糖尿病是Gensini评分的独立危险因素（P＜0.05）；CRP+时,多因素线性回归分析模型分析发现年龄、吸烟、糖尿病以及Lp(a)+是Gensini评分的独立危险因素（P＜0.05）。四组患者中,CRP-/Lp(a)-与冠状动脉狭窄程度的相关性最低,95%CI: 0.111~8.520；CRP+/Lp(a)+组与冠状动脉狭窄程度的相关性最高,（95%CI: 4.674~21.230）。 结论CRP+/Lp(a)+与冠状动脉狭窄程度的相关性比其他任何一组均更高,因此提示高炎症水平的人群中降低Lp(a)可能获益最大。

Abstract:

ObjectiveTo investigate the correlation between lipoprotein(a)[Lp (a)] and coronary stenosis in acute coronary syndrome(ACS) patients with different C-reactive protein(CRP) levels. MethodsA total of 429 patients with acute coronary syndrome were enrolled in the study. Serum CRP and Lp(a) levels were measured with high sensitivity turbidimetry and enzyme-linked immunosorbent assay, respectively. CRP≥10mg/L was defined as CRP+, and CRP<10mg/L was defined as CRP-; Lp(a)≥300ng/mL is defined as Lp(a)+, and Lp(a)<300ng/mL is defined as Lp(a)-. Based on CRP and Lp(a) levels patients were divided into four groups: CRP -/Lp(a)-, CRP-/Lp(a)+, CRP+/Lp(a)-, CRP+/Lp(a)+. The severity of coronary artery stenosis was evaluated by coronary angiography and calculated as the Gensini score. Multivariate logistic regression model was applied to analyze the relationship of CRP and Lp(a) levels with the degree of coronary artery stenosis. ResultsThere were significant differences in age, smoking, hypertension, diabetes, and Gensini score among the four groups（P＜0.05）. Multivariate regression analysis showed that for patients with CRP-, the age, smoking, and diabetes were independent risk factors for Gensini score（P＜0.05）; while for patients with CRP+, the age, smoking, diabetes and LP(a)+ were independent risk factors of Gensini score（P＜0.05）. Patients with CRP-/Lp(a)- had the lowest correlation with coronary artery stenosis(95%CI: 0.111-8.520), while those with CRP+/Lp(a)+ had the highest correlation with coronary artery stenosis(95%CI: 4.674-21.230). ConclusionThe CRP+/Lp(a)+is more close with the degree of coronary artery stenosis, therefore, reducing serum Lp(a) level may bring more benefit in patients with high levels of inflammation.