急性冠状动脉综合征与血脂谱骤变的关系

目的研究急性冠状动脉综合征(ACS)与血脂谱演变之间的关系。方法对143例ACS患者、68例稳定型心绞痛患者和30名健康人分别测试7项血脂谱指标总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(APOA1),载脂蛋白B(APOB)和LP(a)脂蛋白;对ACS之中51例急性心肌梗死(AMI)患者分别测试发作前1周内,发作后1、3、7、14d7项血脂谱指标,血浆心肌酶谱(CK-MB),C反应蛋白(CRP),白介素-6(IL-6)和KILIIP心功能分级;对各组血脂谱的演变及其与CK-MB、CRP、IL-6及KILIIP分级的关系对比和相关分析。结果AMI组比非AMI组、AMI后1～14d4组比AMI前组总胆固醇、LDL-C、HDL-C和APOA1显著降低,LP(a)显著增加(均P<0.01);不稳定型心绞痛组比正常组HDL-C显著降低,总胆固醇、LDL-C、LP(a)显著增加;HDL-C与AMI后1dCK-MB、CRP、IL-6成负相关,LP(a)与AMI后1d3项指标成正相关(均P<0.05);胆固醇与IL-6成负相关(P<0.05),随KILIIP分级增加而显著降低。结论AMI后1～14d存在血脂谱的动态演变,HDL-C、LP(a)骤变与AMI触发,胆固醇骤降与AMI泵衰有关。

Relationship between acte coronary syndrome and acute variations of blood lipid spectrum

Objective To study relationship between acute coronary syndrome and dynamic variations of blood lipid spectrum.Methods 7 indexes of serum lipid spectrumTC,TG,LDL-C,HDL-C,APOA1,APOB,LP(a)] were tested for 143 cases of acute coronary syndrome(ACS)and 68 cases of stable angina and 30 cases of normal individuals(NOM).7 indexes of serum lipid spectrum,CK-MB,CRP,IL-6,cardiac function category by KILIIP criteria in 51 cases of acute myocardial infarction(AMI)of the ACS patients were determined within 1 week before AMI and the 1st,3rd,7th and 14th days after AMI.Dynamic variations of serum lipid spectrum in all groups were investigated and relationships between 7 indexes of serum lipid and CK-MB,CRP,IL-6 as well as KILIIP classifications were analyzed.Results Lower TC,LDL-C,HDL-C and APOA1 and higher LP(a)were found by group AMI vs group NON-AMI and 4 groups within post-AMI 1-14 days vs group pre-AMI.Higher TC,LDL-C,LP(a)and lower HDL-C were found by group of unstable angina vs group NOM.HDL-C were negatively related to CK-MB,CRP and IL-6(all P<0.05),and LP(a)were positively related to later 3 indexes(all P<0.05)in the 1st day of AMI.TC was negatively related to IL-6(P<0.05)and decreasing with KILIIP grade increment(all P<0.05).Conclusion There is a dynamic variation of blood lipid spectrum within post-AMI 1-14 days and a significant relationship between acute variation of HDL-C,as well as LP(a)and AMI attack and between acute decreasing of TC and cardiac pump failure after AMI.