急性心肌梗死患者脂蛋白（a）与冠状动脉病变程度的关系

目的探讨急性心肌梗死（AMI）患者血浆脂蛋白（a）[Lp（a）]与冠状动脉病变程度的关系。方法对136例AMI患者进行血脂检测及冠状动脉造影检查,按血浆Lp（a）水平分为低Lp（a）组（〈300 mg/L,46例）和高Lp（a）组（≥300 mg/L,90例）,比较两组血清Lp（a）浓度及冠状动脉病变特点的差异,应用logistic回归分析及逐步回归分析,观察以上指标与冠状动脉狭窄程度的相关性。结果高Lp（a）组Gensini积分、多支病变构成比例、梗死相关动脉（IRA）闭塞率分别为（145.6±36.2）分、58.9%、86.7%,高于低Lp（a）组（96.8±21.7）分、23.9%、56.5%;高Lp（a）组梗死相关动脉心肌梗死溶栓治疗试验（TIMI）积分为（1.58±0.88）分,低于低Lp（a）组的（2.31±1.07）分（P〈0.05）;回归分析发现,Lp（a）是冠状动脉病变程度I、RA闭塞率和TIMI评分的主要影响因素（P〈0.05或〈0.01）。结论 AMI患者血浆Lp（a）水平,与冠状动脉狭窄程度,IRA血流量、闭塞率及密切相关。

Relation between serum lipoprotein (a) and severity of coronary artery lesion in acute myocardial infarction

Objective To investigate the relation between lipoprotein（a）（Lpa） and severity of coronary artery lesion in patients with acute myocardial infarction（AMI）.Methods 136 patients with AMI were studied,their serum lipids were measured,and coronary angiography was performed.The results were compared between the low Lp（a）（300 mg/L） group and the high Lp（a）（≥300 mg/L） group.The relationship between Lp（a） and severity of coronary artery lesion was further investigated by means of regression analysis.Results Gensini score,the constituent ratio of three vessels disease,and the number of occluded infarct related artery（IRA） in high Lp（a） group were（145.6±36.2） scores,58.9%,86.7%,which were significantly higher than those of low Lp（a） group（96.8±21.7） scores,23.9%,56.5%.The antegrade TIMI flow in the IRA in high Lp（a） group group was（1.58±0.88） scores,which was significantly lower than that of（2.31±1.07） scores in low Lp（a） group（P〈0.05）.The stepwise regression analysis showed closer relationship existing in Gensini score,TIMI flow and the number of occluded IRA（P〈0.05 or 0.01）.Conclusion Elevated Lp（a） level could affect TIMI flow,the number of occluded IRA and the severity of coronary artery atherosclerosis in AMI patients.