骨创伤患者血清脂蛋白（a）的变化及临床意义探讨

目的探讨骨创伤患者血清脂蛋白（a）[Lp（a）]的变化及临床意义。方法用免疫比浊法动态检测骨创伤患者（受伤24 h、72 h、1周、1个月）的血清Lp（a）水平,并与健康对照组和疾病对照组的血清Lp（a）水平作比较,观察骨创伤患者的血清Lp（a）的动态变化。结果12.5%的正常人血清Lp（a）水平超过300 mg/L,中位数（范围）为95.5（30.3-435.9）mg/L。受伤24 h、72 h、1周、1个月时采集静脉血,分别有33.3%、35.7%、38.1%、16.6%骨创伤患者的血清Lp（a）水平超过300 mg/L,中位数（范围）分别为145.5（36.3-1 260.8）、203.4（42.1-1 119.8）、164.9（39.0-1 007.6）、103.9（32.1-596.4）mg/L,受伤24 h、72 h、1周时骨创伤患者的血清Lp（a）水平明显高于对照组（P〈0.05）,1个月后骨创伤患者的血清Lp（a）水平基本恢复正常,与健康对照组比较无明显差异（P〉0.05）;疾病对照组中,术前有10%的患者血清Lp（a）水平超过300 mg/L,中位数（范围）为97.9（22.4-436.4）mg/L,术后24 h、72 h、1周、1个月时采集静脉血,分别有20%、30%、20%、15%手术患者的血清Lp（a）水平超过300 mg/L,中位数（范围）分别为142.9（26.9-800.1）、172.0（50.6-890.8）、143.9（39.8-808.1）、110.6（29.6-600.4）mg/L;疾病对照组与健康对照组相比,术后72 h的血清Lp（a）水平明显高于健康对照组（P〈0.05）,疾病对照组术后其余时段的血清Lp（a）水平与健康对照组比较无明显差异（P〉0.05）;疾病对照组术后与骨创伤组相同时段的血清Lp（a）水平比较无明显差异（P〉0.05）,但是疾病对照组术后的血清Lp（a）水平峰值低于骨创伤组。结论创伤患者的血清Lp（a）水平明显升高,约1个月后基本恢复正常,骨创伤患者的血清Lp（a）峰值高于疾病对照组术后的血清Lp（a）峰值。

The change of serum lipoprotein(a) of wounded-bone patient and its clinical significance

Objective To study the change of serum lipoprotein（a） of wounded-bone patient and its clinical sigificance.Methods The levels of serum Lp（a） of wounded-bone patients and healthy subjects were detected by immunological turbidimetry,and then the dynamic change between wounded patients and the healthy subjects was analyzed.Results Serum Lp（a） levels of 12.5% healthy subjects were more than 300 mg/L,and the median was 95.5（30.3-435.9） mg/L.Among the wounded-bone patients,when they were wounded after 24 h,72 h,1 week and 1 month,there were 33.3%,35.7%,38.1% and 16.6% patients′ Lp（a） levels more than 300 mg/L.Their serum Lp（a） levels（medians） were 145.5（36.3-1 260.8）,203.4（42.1-1 119.8）,164.9（39.0-1 007.6） and 103.9（32.1-596.4） mg/L.Serum Lp（a） levels of wounded-bone patients were higher than those of healthy subjects when the patients were wounded after 24 h,72 h and 1 week（P〈0.05）.When the patients were wounded after 1 month,serum Lp（a） levels of patients were same with the healthy subjects′（P〉0.05）.Serum Lp（a） levels of 10% patients before operation were more than 300 mg/L,and the median in these patients was 97.9（22.4-436.4） mg/L.At 24 h,72 h,1 week and 1 month after operation,there were respectively 20%,30%,20% and 15% patients′ Lp（a） levels more than 300 mg/L,and their medians were respectively 142.9（26.9-800.1）,172.0（50.6-890.8）,143.9（39.8-808.1） and 110.6（29.6-600.4） mg/L.Comparing the results between the patients and the healthy controls,serum Lp（a） levels in disease controls were significantly higher than those in healthy controls at 72 h after operation（P〈0.05）.There was no difference at 24 h,1 week and 1 month after operation（P〉0.05）.Comparing the wounded-bone patients′ Lp（a） levels and the levels after operation at the same period,there was no remarkable difference（P〉0.05）,but Lp（a） peak level of operated patient in disease controls was lower than that in wounded-bone patients.Conclusions Serum Lp（a） levels of wounded patients are remarkably higher than those in healthy subjects,but when they are wounded after 1 month,their serum Lp（a） levels become normal.Serum Lp（a） peak level of wounded-bone patient is higher than that of operated patients in disease controls.