脂蛋白(a)与冠心病的研究

脂蛋白(a)[Lp(a)]由低密度脂蛋白(LDL)和载脂蛋白(a)组成。Lp(a)的血浆浓度主要由遗传因素决定,并与其基因多态性相关,具有个体及种族差异。Lp(a)有促动脉粥样硬化(AS)作用,其血浆浓度与冠心病(CHD)密切相关,是AS及CHD的独立危险因素。烟酸缓释制剂是目前治疗高Lp(a)血症最有效的药物。     

脂蛋白(a)与冠心病的研究

脂蛋白(a)[Lp(a)]由低密度脂蛋白(LDL)和载脂蛋白(a)组成.Lp(a)的血浆浓度主要由遗传因素决定,并与其基因多态性相关,具有个体及种族差异.Lp(a)有促动脉粥样硬化(AS)作用,其血浆浓度与冠心病(CHD)密切相关,是AS及CHD的独立危险因素.烟酸缓释制剂是目前治疗高Lp(a)血症最有效的药物.     

早发性冠心病患者脂蛋白(a)水平变化

观察较早发生的冠心病(CHD)患者的血清脂蛋白(a)[Lp(a)]水平变化.方法:用ELISA法测定经冠脉造影证实的185例CHD患者及31例对照(NS)Lp(a)水平.结果:(1)血清Lp(a)水平在185例CHD患者明显高于31例NS组(216.96±215.39比119.68±71.07mg/L,P<0.02).(2)CHD组中,血清Lp(a)水平,在80例<55岁比105例≥55岁者明显升高(252.86±253.77比189.61±177.24mg/P<0.05).结论:血清Lp(a)水平升高可能在较早发生的冠心病患者中更为明显.     

不同血糖水平冠心病患者冠脉病变与脂蛋白(a)关系研究

目的 探讨不同血糖水平冠心病患者脂蛋白(a)与冠脉病变的关系.方法 对150例经冠脉造影检查确诊的冠心病患者进行回顾性分析,并对冠状动脉进行定性和定量评价,比较在不同血糖水平下脂蛋白(a)与冠脉病变的关系.结果 3组冠心病患者之间年龄、吸烟史、高血压病史、胆固醇及三酰甘油比较无统计学意义,而随着血糖水平升高,低密度脂蛋白逐渐升高,高密度脂蛋白逐渐降低,与单纯冠心病(CHD)组比较糖尿病(DM)组脂蛋白(a)水平明显升高;与CHD组比较冠心病合并空腹血糖受损组(IFG)组、DM组3支病变较多见(P＜0.05).结论 冠心病合并空腹血糖异常者以及冠心病合并糖尿病患者,冠脉病变较严重且病变支数以多支病变常见,冠心病合并糖尿病患者脂蛋白(a)明显升高.     

哈萨克族冠心病患者冠状动脉病变与脂蛋白(a)相关性研究

目的了解哈萨克族冠心病患者冠状动脉病变程度与脂蛋白(a)[LP(a)]水平的关系。方法经选择性冠状动脉造影确定患者40例(冠状动脉直径狭窄≥50%)同时测定血清LP(a)水平,与健康对照组40例相比。结果冠心病组LP(a)[(338.7±179.6)mg/L]的水平明显高于对照组[(219.8±126.8)mg/L](P<0.05);LP(a)与冠状动脉狭窄的程度呈正相关(r=0.487,P<0.05);随LP(a)水平的升高,冠状动脉病变支数也增加。结论哈萨克族冠心病患者LP(a)水平升高,病变程度越重LP(a)水平越高。     

脂蛋白(a)水平影响因素及其与长寿的关系

<正>脂蛋白(Lp)(a)是一种独特的血浆脂蛋白大分子复合物,由富含胆固醇的低密度脂蛋白(LDL)样微粒通过载脂蛋白(Apo)B100与Apo(a)由一个二硫键交链在一起。它于1963年由挪威学者Berg~([1])首先发现并命名报道后,有多项研究相继证实其为动脉粥样硬化的危险因素,高Lp(a)水平是心血管疾病的独立危险因子,就如同低密度脂蛋白胆固醇(LDL-C)一     

脂蛋白(a)与心血管疾病的关系

脂蛋白(a)[Lp(a)]结构类似于低密度脂蛋白(LDL),高水平Lp(a)是一种公认的心血管疾病危险因子。体内存在氧化型Lp(a)更易于促进动脉粥样硬化的发生发展。Lp(a)中的载脂蛋白(a)[apo(a)]存在异质性,研究显示其危险性可能是由于apo(a)等位基因水平差异引起的,而且apo(a)的多态性影响到Lp(a)水平的临床测定,如何降低apo(a)对结果的影响还需要更多深入研究。目前针对高Lp(a)水平的人群尚无统一的治疗标准,但降脂治疗有益于预防心脑血管疾病的发生。     

脂蛋白(a)和载脂蛋白(a)多态性与女性冠心病的相关性研究

冠心病在病因、发病年龄等诸多方面存在性别差异。载脂蛋白（ａ）多态性与脂蛋白（ａ）血浆水平对女性冠心病影响的资料甚少。我们通过检测３５例女性冠心病患者和４５例女性正常对照者的载脂蛋白（ａ）多态表型及脂蛋白（ａ）水平，并与相应的男性组对比分析，发现含有等位基因Ｓ１、Ｓ２、Ｂ的载脂蛋白（ａ）低分子量表型的冠心病患者，女性占３７．１４％，显著高于对照组；而男性仅占２５．７１％，与对照组比较差异无显著性。在女性体内载脂蛋白（ａ）低分子量表型发生冠心病的危险度为对照组的４．７倍；在男性中仅为１．４倍。结果提示：载脂蛋白（ａ）低分子量表型对女性冠心病的影响大于男性。脂蛋白（ａ）水平在两性冠心病患者中均明显高于对照组，而两性之间的差异无显著性。     

脂蛋白(a)与动脉粥样硬化研究进展

脂蛋白(a)由低密度脂蛋白和载脂蛋白(a)组成.高血浆脂蛋白(a)水平是动脉粥样硬化和心血管疾病的独立危险因素.脂蛋白(a)不但能参与动脉粥样硬化斑块的形成,还能影响抗炎机制和血管壁中促凝与抗凝因子的平衡.血浆脂蛋白(a)水平的个体差异很大,主要受遗传因素控制.血浆脂蛋白(a)水平对药理和非药理因素都不敏感,临床上缺乏高效安全降低脂蛋白(a)水平的治疗方法.近年,科研工作者发现反义寡核苷酸链和人工合成的肽链等可以降低脂蛋白(a)水平,但用于临床治疗还需进一步研究.本文拟对近年来脂蛋白(a)与动脉粥样硬化研究的新进展进行综述.     

血清同型半胱氨酸及脂蛋白(a)与冠心病的相关性研究

目的探讨血清同型半胱氨酸及脂蛋白(a)与冠状动脉粥样硬化性心脏病(冠心病,CHD)的相关性。方法纳入经冠状动脉造影(CAG)确诊的冠心病患者84例,并将其分为稳定型心绞痛组(SAP组,28例)、急性冠脉综合症组(ACS组,56例)。另选同期56例拟诊为CHD而CAG正常的患者作为对照组(NC组)。检测各组血清同型半胱氨酸(Hcy)、脂蛋白a[Lp(a)]水平,同时根据冠状动脉(冠脉)造影结果对入选者行Gensini评分;对冠心病的多项危险因素进行多元logistic回归模型分析。结果 ACS组、SAP组与NC组患者血清Hcy、Lp(a)水平差异具有统计学意义(P0.05)。Pearson直线相关分析示,CHD患者Hcy、Lp(a)水平无相关性(r=0.240,P0.05),Gensini积分与血清Hcy、Lp(a)水平分别呈正相关(r=0.78、0.75,P均0.05)。多元Logistic回归分析显示Hcy(OR=1.287,95%CI:1.027~1.791)及Lp(a)(OR=3.038,95%CI:2.984~3.431)为冠心病的独立危险因素。结论高Hcy及高Lp(a)是冠心病的独立危险因素,与冠状动脉病变的严重程度相关。     

脂蛋白(a)水平与冠心病患者易损斑块独立相关

目的基于光学相干断层成像技术(OCT)研究脂蛋白(a)水平与冠状动脉易损斑块之间的相关性。方法入选2015年1月至2018年8月在新疆医科大学第一附属医院心脏中心住院并经冠状动脉造影确诊为冠心病的患者,进行光学相干断层成像(OCT)检查。应用多重线性回归等统计方法分析脂蛋白(a)水平与冠状动脉易损斑块之间的关系。结果共入选144例患者。(1)根据脂蛋白(a)水平将患者分为脂蛋白(a)≤300 mg/L组(n=99)和脂蛋白(a)300 mg/L组(n=45);脂蛋白(a)300 mg/L组斑块脂质弧比脂蛋白(a)≤300 mg/L组大(P=0.021),易损斑块发生率比脂蛋白(a)≤300 mg/L组高(P=0.001)。(2)利用OCT将患者分为易损斑块组(n=36)和非易损斑块组(n=108),2组之间性别、吸烟史、2型糖尿病、体质指数、低密度脂蛋白、脂蛋白(a)差异均有统计学意义(均P0.05);多因素Logistic回归分析显示,脂蛋白(a)、2型糖尿病、低密度脂蛋白为易损斑块的独立影响因素,是易损斑块发生的预测因子。结论高水平脂蛋白(a)与冠状动脉易损斑块独立相关。     

Association of elevated lipoprotein(a) levels and coronary heart disease in NIDDM patients. Relationship with apolipoprotein(a) phenotypes

Summary Non-insulin-dependent diabetes mellitus (NIDDM) is a strong and independent risk factor for coronary heart disease. We assessed the potential relationship between plasma Lp(a) levels, apo(a) phenotypes and coronary heart disease in a population of NIDDM patients. Seventy-one patients with coronary heart disease, who previously have had transmural myocardial infarction, or significant stenosis on coronary angiography, or positive myocardial thallium scintigraphy, or in combination, were compared with 67 patients without coronary heart disease, who tested negatively upon either coronary angiography, myocardial thallium scintigraphy or a maximal exercise test. The prevalence of plasma Lp(a) levels elevated above the threshold for increased cardiovascular risk (>0.30 g/l) was significantly higher (p=0.005) in patients with coronary heart disease (33.8%) compared to the control group (13.4%). The relative risk (odds ratio) of coronary heart disease among patients with high Lp(a) concentrations was 3.1 (95% confidence interval, 1.31–7.34;p=0.01). The overall frequency distribution of apo(a) phenotypes differed significantly between the two groups (p=0.043). However, the frequency of apo(a) isoforms of low apparent molecular mass (700 kDa) was of borderline significance (p=0.067) between patients with or without coronary heart disease (29.6% and 16.4%, respectively). In this Caucasian population of NIDDM patients, elevated Lp(a) levels were associated with coronary heart disease, an association which was partially accounted for by the higher frequency of apo(a) isoforms of small size. In multivariate analyses, elevated levels of Lp(a) were independently associated with coronary heart disease (odds ratio 3.48, p=0.0233).Abbreviations NIDDM Non-insulin-dependent diabetes mellitus - IDDM insulin-dependent diabetes mellitus - CHD coronary heart disease - Lp(a) lipoprotein(a) - apo(a) apolipoprotein(a) - apoB apolipoprotein B - HMGCoA reductase hydroxymethylglutaryl coenzyme A reductase     

脂蛋白(a)基因多态性与冠心病相关性的Meta分析

目的 评估脂蛋白(a)基因(LPA)多态性与冠心病风险之间的相关性.方法 检索PubMed、Embase、Web of Science、Cochran、中国知网和万方数据库中LPA基因rs10455872和/或rs3798220多态性与冠心病的关联研究,检索时限均为建库至2021年6月10日.由两名研究者独立筛选文献、...     

Apolipoprotein(a) size polymorphism is associated with coronary heart disease in polygenic hypercholesterolemia

BACKGROUND AND AIM: In addition to high serum cholesterol levels, various cardiovascular risk factors may be involved in the development of coronary heart disease (CHD) in hypercholesterolemic subjects. As the levels of lipoprotein(a) [Lp(a)], an important and independent cardiovascular risk factor, are high in polygenic hypercholesterolemia (PH), we investigated plasma Lp(a) levels and apolipoprotein(a) [apo(a)] phenotypes in relation to occurrence of CHD events in PH patients. METHODS AND RESULTS: Lp(a) levels and apo(a) isoforms were determined in 191 PH patients, 83 normocholesterolemic subjects with CHD, and 94 normocholesterolemic controls without CHD. Lp(a) levels were similar in the hypercholesterolemic subjects with (n=100) or without CHD (n=91): 21.4 (range 6.6-59.23) vs 18.5 (range 5.25-57.25) mg/dL (p=NS). Low molecular weight apo(a) isoforms were more prevalent (55%) in the PH patients with CHD, whereas high molecular weight apo(a) isoforms were more prevalent (62.6%) in those without CHD: this difference was significant (p<0.05). A stepwise multiple-discriminant analysis made in order to determine the independence of common cardiovascular risk factors, Lp(a) levels and low molecular weight apo(a) isoforms in predicting CHD among hypercholesterolemic subjects showed that the presence of a positive family history of CHD, smoking, age, and the presence of at least one apo(a) isoform of low molecular weight were independently associated with CHD. CONCLUSIONS: Despite high Lp(a) levels, our findings do not support the hypothesis that Lp(a) plays an independent role in determining clinical CHD in PH subjects. However, the presence of at least one low molecular weight apo(a) isoform is an independent genetic predictor of CHD in hypercholesterolemic subjects. Together with other cardiovascular risk factors, apo(a) phenotypes should be assessed to evaluate the overall CHD risk status of all subjects with high serum cholesterol levels.     

2型糖尿病患者血清脂蛋白(a)水平及其与冠心病的关系

目的　探讨 2型糖尿病患者血清脂蛋白 (a) [Lp(a) ]水平及其与冠心病的关系。方法　选择 90例 2型糖尿病及 6 8例健康对照者测定其血清Lp(a)、总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白胆固醇 (HDL C)水平 ;计算低密度脂蛋白胆固醇 (LDL C)水平及TC、TG、LDL C与HDL C比值。结果　 (1)糖尿病组血清Lp(a)水平与对照组比较差异无显著性意义 (P >0 .0 5 )。 (2 )将 2型糖尿病患者分为糖尿病伴冠心病和单纯糖尿病亚组后发现 :①糖尿病伴冠心病亚组血清Lp(a)水平明显高于单纯糖尿病亚组 [(2 3.78± 2 3.73)mg/dlvs (13.31± 10 .6 6 )mg/dl;P <0 .0 1]及对照组 [(2 3.78± 2 3.73)mg/dlvs (16 .2 8± 17.95 )mg/dl;P <0 .0 5 ];②糖尿病伴冠心病亚组血清Lp(a)水平与LDL C呈正相关关系 (r =0 .32 16 ,P <0 .0 5 )。结论　 2型糖尿病患者血清Lp(a)水平增高可能与冠心病发病有密切关系。     

脂蛋白（a）浓度变化与急性冠脉综合征患者预后的关系

目的探讨血清脂蛋白（a）[1ipoprotein（a）,Lp（a）]浓度以及Lp（a）浓度的变化对经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗完全血运重建后的急性冠脉综合征（acute coronary syndrome,ACS）患者预后的影响。方法选取240例因ACS行冠状动脉支架植入术并予常规药物治疗的患者,临床随访一年。检测基线及随访半年时Lp（a）浓度,并收集传统的心血管危险因素以及主要心血管事件（major adverse cardiac events,MACE）的资料。通过多因素Logistic回归的方法评价血清Lp（a）浓度的变化（基线水平至随访半年的变化）是否与ACS患者预后相关。结果基线血清Lp（a）浓度与冠状动脉Gensini评分呈正相关（r=0．142,P=O．027）,与糖尿病的发生（r=-0．182,P=0．005）以及三酰甘油浓度（r=-0．156,P=O．016）呈负相关。在MACE发生的患者中,Lp（a）浓度平均升高了50mg／L,而在非MACE患者中平均下降了40mg／L。单因素Logistic回归分析发现基线Lp（a）浓度与MACE的发生无明显关系（OR=1．123,P=O．753）,并筛选年龄（OR=1．03,P=O．060）,Gensini评分（OR=1．010,P=0．015）,原发性高血压（OR=1．696,P=O．069）,糖尿病（OR=1．818,P=O．060）以及血清Lp（a）浓度变化的差值（OR=0．027,P=O．027）进入多因素Logistic逐步回归分析,发现Lp（a）浓度的变化（OR=3．119,95％CI=1．112～8．746,P=O．031）以及Gensini评分（OR=I．010,95％CI=1．002～1．018,P=O．016）可能是影响ACS预后的独立危险因素。结论基线血清Lp（a）浓度与ACS的预后无明显相关,与糖尿病的发生以及三酰甘油浓度呈负相关一存晡访讨程申向洁Tp（a）浓度的变化可能是ACS不良预后的独立危险因素.     

Lipoprotein (a) and vascular disease in diabetic patients

Summary In order to assess the potential role of lipoprotein(a) as a risk factor for cardiovascular disease in diabetes mellitus, plasma concentrations were measured in a large group (n=500) of non-insulin-dependent (NIDDM, n=355) and insulin-dependent (IDDM, n=145) patients. Concentrations of lipoprotein (a) were compared in diabetic patients with (n=153) or without (347) documented vascular disease (ischaemic heart disease, peripheral vascular disease or macroangiopathy). They were significantly higher (p<0.05) in patients with ischaemic heart disease (mean [interquartile range] 15.5 (5.0–38.0) vs 9.0 (4.5–26.0) mg/dl) or macroangiopathy (13.0 (5.0–38.0) vs 9.0 (4.0–25.0) mg/dl) compared to patients without manifestations of vascular disease. In addition, stepwise logistic regression analysis identified lipoprotein (a) levels 30 mg/dl as being independently associated with the presence of cardiovascular disease. Lipoprotein (a) was an independent risk factor for ischaemic heart disease and macroangiopathy in this group of IDDM and NIDDM patients.Abbreviations Lp(a) lipoprotein (a) - LDL low density lipoproteins - CVD cardiovascular disease - IHD ischaemic heart disease - PVD peripheral vascular disease - HDL high density lipoproteins     

低密度脂蛋白胆固醇水平与冠状动脉病变的关系

目的探讨血清低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL—C）水平与冠心病患者冠状动脉病变的关系。方法经选择性冠状动脉造影328例，根据冠状动脉造影结果分为冠心病组和对照组；冠心病组根据病变范围分为单支病变、双支病变、多支病变：根据病变狭窄程度分为轻度、中度、重度狭窄组。分别测定其血脂水平。结果冠心病组甘油三酯、LDL-C和总胆固醇水平明显高于对照组。总胆固醇和LDL—C水平与冠状动脉病变呈正相关；双支病变组与三支病变组明显高于对照组及单支病变组（P〈0．01），中度狭窄组和重度狭窄组明显高于对照组及轻度狭窄组（P〈0．01）。结论总胆固醇与LDL-C能够反映冠心病患者冠状动脉的病变情况，其水平随冠状动脉病变范围及病变程度的加重而升高，可作为预测冠状动脉病变的一个因素。