脂蛋白(a)水平与冠心病患者疾病发生及严重程度的相关性初探

目的：本研究旨在探究未经治疗的CAD患者中，Lp (a)在预测CAD发病和严重程度方面的作用。方法：本研究连续入选1980名接受冠脉造影的患者，其中1162名确诊患有CAD，用Gensini评分（GS）来评估CAD严重程度，免疫比浊法测定Lp (a)。结果：与无CAD患者相比，CAD患者LDL-C水平更高（P<0.05)。多变量Logistic回归分析表明Lp (a)>205mg/L(第三分位) 时患CAD的风险是Lp(a)处于第一分位者的1.437倍(95% CI:1.108-1.865,P=0.006)，高GS的风险是Lp(a)处于第一分位者的1.480倍(95% CI:1.090-2.009,P=0.012)。而且，高水平的Lp (a)和LDL-C并存时预示着CAD发病风险OR = 1.845, 95% CI: 1.339-2.541, P < 0.001]和冠状动脉严重程度OR = 1.736, 95% CI: 1.188-2.538, P = 0.004]最高。结论：脂蛋白a可作为预测冠脉疾病存在和程度的标记物，尤其是与LDL-C联合使用时。

Lipoprotein (a) as a Marker for Predicting the Presence and Severity of Coronary Artery Disease in Untreated Chinese Patients Undergoing Coronary Angiography

Objective Low-density lipoprotein cholesterol (LDL-C) has been well known as a risk factor for coronary artery disease (CAD). However, the role of lipoprotein (a) Lp(a)] in the development of CAD is of great interest but still controversial. Thus, we aim to explore the effect of Lp(a) on predicting the presence and severity of CAD in Chinese untreated patients, especially in combination with LDL-C. Methods We consecutively recruited 1,980 non-treated patients undergoing coronary angiography, among which 1,162 patients were diagnosed with CAD. Gensini score (GS) was used to assess the severity of CAD. Lp(a) was measured by immunoturbidimetric method. Results Patients with CAD had higher level of LDL-C and Lp(a) compared with non-CAD (P < 0.05). Multivariable logistic regression revealed that Lp(a) > 205 mg/L (highest tertile) predicted 1.437-fold risk for CAD (95% CI: 1.108-1.865, P = 0.006) and 1.480-fold risk for high GS (95% CI: 1.090-2.009, P = 0.012) respectively. Interestingly, concomitant elevated level of Lp(a) and LDL-C conferred the highest risk for both presence OR = 1.845, 95% CI: 1.339-2.541, P < 0.001] and severity OR = 1.736, 95% CI: 1.188-2.538, P = 0.004] of CAD. Conclusion Lipoprotein (a) is a useful marker for predicting the presence and severity of CAD, especially combined with LDL-C.