CAJ | 학술논문

目的探讨血清脂蛋白(a)[Lp(a)]、纤维蛋白原(Fig)和超敏C反应蛋白(hs-CRP)与冠状动脉粥样硬化程度的关系,评价三者对冠心病的临床诊断价值.方法对358例疑诊冠心病而接受冠状动脉造影的患者同期检测血清Lp(a)、Fig和hs-CRP,并检测三酰甘油 (TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿素氮(BUN)和肌酐(Cr).根据冠状动脉狭窄情况分为冠状动脉正常组(冠状动脉无狭窄,29例)、冠状动脉粥样硬化组(冠状动脉狭窄＜50%,91例)、冠状动脉单支病变组(仅有一支冠状动脉分支狭窄≥50%,103例)和多支病变组(有一支以上冠状动脉分支狭窄≥50%,135例),并在每组内分高LDL-C亚组和正常LDL-C亚组.结果各组间Lp(a)和Fig水平依次递增,多支病变组和单支病变组较正常组分别升高了40.0%、22.3% (P＜0.05)和43.8%、25.5% (P＜0.05);且多支病变组与单支病变组比较差异亦有统计学意义(P＜0.05).hs-CRP水平多支病变组[(0.94±0.83)mg/L]和单支病变组[(0.62±0.77) mg/L]与正常组[(0.16±0.43) mg/L]间差异均有统计学意义(P＜0.05);同时,多支病变组较单支病变组升高了50.9% (P＜0.05).在剔除了LDL-C影响后亚组分析中,也得出类似结果.单因素Logistic回归分析表明血清Lp(a)、Fig和hs-CRP均为影响冠状动脉病变的因素,其中hs-CRP的OR值最大,OR为1.112,OR的95% CI(1.022～1.188).进一步多因素Logistic回归分析表明,Lp(a)、Fig、hs-CRP、LDL-C和血糖均入选回归模型.hs-CRP与Lp(a)、Fig均呈正相关(r值分别为1.136和1.127,P<0.01).结论 (1)随着冠状动脉病变程度加重,Lp(a)、Fig和hs-CRP水平显著增高.(2)hs-CRP对冠心病的预测价值大于Lp(a)和Fig,但Lp(a)和Fig与hs-CRP均呈正相关性.
목적 탐토혈청지단백(a)[Lp(a)]、섬유단백원(Fig)화초민C반응단백(hs-CRP)여관상동맥죽양경화정도적관계,평개삼자대관심병적림상진단개치.방법 대358례의진관심병이접수관상동맥조영적환자동기검측혈청Lp(a)、Fig화hs-CRP,병검측삼선감유 (TG)、총담고순(TC)、고밀도지단백담고순(HDL-C)、저밀도지단백담고순(LDL-C)、뇨소담(BUN)화기항(Cr).근거관상동맥협착정황분위관상동맥정상조(관상동맥무협착,29례)、관상동맥죽양경화조(관상동맥협착＜50%,91례)、관상동맥단지병변조(부유일지관상동맥분지협착≥50%,103례)화다지병변조(유일지이상관상동맥분지협착≥50%,135례),병재매조내분고LDL-C아조화정상LDL-C아조.결과 각조간Lp(a)화Fig수평의차체증,다지병변조화단지병변조교정상조분별승고료40.0%、22.3% (P＜0.05)화43.8%、25.5% (P＜0.05);차다지병변조여단지병변조비교차이역유통계학의의(P＜0.05).hs-CRP수평다지병변조[(0.94±0.83)mg/L]화단지병변조[(0.62±0.77) mg/L]여정상조[(0.16±0.43) mg/L]간차이균유통계학의의(P＜0.05);동시,다지병변조교단지병변조승고료50.9% (P＜0.05).재척제료LDL-C영향후아조분석중,야득출유사결과.단인소Logistic회귀분석표명혈청Lp(a)、Fig화hs-CRP균위영향관상동맥병변적인소,기중hs-CRP적OR치최대,OR위1.112,OR적95% CI(1.022～1.188).진일보다인소Logistic회귀분석표명,Lp(a)、Fig、hs-CRP、LDL-C화혈당균입선회귀모형.hs-CRP여Lp(a)、Fig균정정상관(r치분별위1.136화1.127,P<0.01).결론 (1)수착관상동맥병변정도가중,Lp(a)、Fig화hs-CRP수평현저증고.(2)hs-CRP대관심병적예측개치대우Lp(a)화Fig,단Lp(a)화Fig여hs-CRP균정정상관성.
Objective To investigate the association of lipoprotein(a),fibrinogen,and hs-CRP with coronary artery lesion.Methods Totally 358 patients who had undergone coronary angioplasty and completed clinical examination of trigcylglycerol (TG),blood cholesterol (TC),low-density lipoprotein-cholesterol (LDL-C),high-density lipoprotein-cholesterol (HDL-C),blood urea nitrogen (BUN) and serum creatinine (SCr) were divided into the normal vessel (NV) group (n=29),scleratheroma (SC) group (coronary stenosis <50%,n=91),single vessel disease (SVD) group (with only one vessel stenosis≥50%,n=103),and multiple vessels disease (MVD) group (with more than one vessel stenosis ≥50%,n=135) according to the angiographic results.All the patients in each group were further devided into the high LDL-C and normal LDL-C subgroups.Results The levels of lipoprotein(a) and fibrinogen increased in the SVD group and MVD group compared with that in NV group (40.0%,22.3% and 43.8%,25.5%.both P＜0.05).Significant difference was also found between SVD group and MVD group [(137.82±87.09)mg/L vs (158.85±103.03)mg/L and(3.09±0.72)g/L vs(3.41±1.05)g/L,both P＜0.05].The levels of hs-CRP were significantly higher in SVD group and MVD group than in NV group [(0.62±0.77)mg/L vs (0.16±0.43)mg/L and (0.94±0.83)mg/L vs(0.16±0.43)mg/L,both P＜0.05].The level of hs-CRP in MVD group was also significantly higher than that in SVD group [(0.94±0.83)mg/L vs(0.62±0.77)mg/L,P＜0.05].Single factor logistic regression analysis showed that lipoprotein(a),fibrinogen,and hs-CRP are all correlation factors of coronary artery lession while hs-CRP had the highest odds ratio (OR) value (OR1.112,95%CI 1.022 - 1.188).Advanced multi-factor logistic regression analysis showed that hs-CRP has significantly stronger correlation with coronary artery lesion when compared with lipoprotein(a) and fibrinogen (r=1.136 and 1.127,P＜0.01,respectively).Conclusion The levels of lipoprotein(a),fibrinogen,and hs-CRP increase when the severity of coronary lesion increases.Although lipoprotein(a) and fibrinogen are positively correlated with hs-CRP,hs-CRP has a higher predictive value for coronary diseases than lipoprotein(a) and fibrinogen.