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中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 164 -170. doi: 10.3877/cma.j.issn.1674-0785.2021.03.002

临床研究

2型糖尿病患者血清脂蛋白(a)水平与冠状动脉粥样硬化性心脏病发生风险及严重程度的相关性
顾俊旭1, 邢垚1, 苏明1, 贾玫1, 王春燕1,()   
  1. 1. 100044 北京,北京大学人民医院检验科
  • 收稿日期:2021-02-15 出版日期:2021-03-15
  • 通信作者: 王春燕
  • 基金资助:
    北京市科技计划项目(Z181100001718156); 北京市自然科学基金(5192022)

Relationship between serum lipoprotein (a) level and risk and severity of coronary atherosclerotic heart disease in patients with type 2 diabetes mellitus

Junxu Gu1, Yao Xing1, Ming Su1, Mei Jia1, Chunyan Wang1,()   

  1. 1. Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
  • Received:2021-02-15 Published:2021-03-15
  • Corresponding author: Chunyan Wang
引用本文:

顾俊旭, 邢垚, 苏明, 贾玫, 王春燕. 2型糖尿病患者血清脂蛋白(a)水平与冠状动脉粥样硬化性心脏病发生风险及严重程度的相关性[J/OL]. 中华临床医师杂志(电子版), 2021, 15(03): 164-170.

Junxu Gu, Yao Xing, Ming Su, Mei Jia, Chunyan Wang. Relationship between serum lipoprotein (a) level and risk and severity of coronary atherosclerotic heart disease in patients with type 2 diabetes mellitus[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(03): 164-170.

目的

探讨脂蛋白(a)[Lp(a)]在2型糖尿病(T2DM)患者中与冠状动脉粥样硬化性心脏病(CAHD)发生风险及严重程度的关系。

方法

选择2017年1月至2019年12月在北京大学人民医院就诊的T2DM患者1228例(男性717例,女性511例)。根据冠状动脉造影(CAG)结果分为CAHD组和non-CAHD组。糖尿病合并CAHD患者按照堵塞支数分为单支病变组、双支病变组和多支病变组,并根据Gensini评分(GS)分为低GS组(GS≤25分)、中GS组(GS 26~40分)、高GS组(GS≥41分)。采用二元Logistic逐步回归方程评估Lp(a)与CAHD发生风险及严重程度关系。

结果

CAHD组血清Lp(a)水平明显高于non-CAHD组[39.82(48.06)nmol/L vs 38.27(33.64)nmol/L,Z=-2.595,P=0.006]。多支病变组Lp(a)水平显著升高[32.81(40.73)nmol/L vs 39.47(45.54)nmol/L vs 43.51(49.94)nmol/L,H=18.440,P<0.001];高GS组血清Lp(a)水平显著高于其他2组[33.74(40.75)nmol/L vs 39.57(45.63)nmol/L vs 46.21(52.75),H=20.548,P<0.001]。根据Mantel-Haenszel线性趋势检验分析得出,随着血清Lp(a)水平的升高,冠状动脉阻塞程度加重(P<0.001)。经过二元Logistic逐步回归方程分析得到Lp(a)水平与CAHD发生风险及其严重程度独立相关(CAHD组vs non-CAHD组:OR=2.207,95%CI:1.790~5.060,P=0.026;多支病变组vs单支病变组:OR=3.288,95%CI:1.871~7.278,P=0.035;高GS组vs低GS组:OR=2.556,95%CI:2.046~5.378,P=0.023)。

结论

在T2DM患者中,Lp(a)升高是CAHD的独立风险因素并于与CAHD的严重程度相关。

Objective

To investigate the relationship between lipoprotein (a)[Lp(a)] and the risk and severity of coronary atherosclerotic heart disease (CAHD) in patients with type 2 diabetes mellitus (T2DM).

Methods

From January 2017 to December 2019, 1228 T2DM patients (717 males and 511 females) were treated at Peking University People's Hospital. According to the results of coronary angiography (CAG), they were divided into either a CAHD group or a non-CAHD group. Diabetic patients with CAHD were further divided into a single vessel disease subgroup, double vessel disease subgroup, and multiple vessel disease subgroup according to the number of blocked vessels, or further divided into a low Gensini score (GS) subgroup (GS ≤ 25), medium GS subgroup (GS: 26-40), and high GS subgroup (GS ≥ 41) according to GS. Binary Logistic stepwise regression was used to evaluate the relationship between Lp(a) and the risk and severity of CAHD.

Results

Serum Lp(a) level in the CAHD group was significantly higher than that of the non-CAHD group [39.82 (48.06) nmol/L vs 38.27 (33.64) nmol/L, Z=-2.595, P=0.006], and the level of Lp(a) in patients with multi-vessel disease was significantly increased compared with those with single or double vessel disease [32.81 (40.73) nmol/L vs 39.47 (45.54) nmol/L and 43.51 (49.94) nmol/L, H=18.440, P<0.001]. The level of serum Lp(a) in patients with high GS was significantly higher than those of the other two subgroups [33.74 (40.75) nmol/L vs 39.57 (45.63) nmol/L and 46.21 (52.75) nmol/L, H=20.548, P<0.001]. According to Mantel-Haenszel linear trend test analysis, with the increase of serum Lp(a) level, the degree of coronary artery occlusion increased (P<0.001). Logistic regression analysis showed that Lp(a) level was still independently associated with the risk and severity of CAHD [CAHD group vs non-CAHD group: odds ratio (OR)=2.207, 95% confidence interval (CI): 1.790-5.060, P=0.026; multi-vessel subgroup vs single vessel subgroup: OR=3.288, 95%CI: 1.871-7.278, P=0.035; high GS group vs low GS group: OR=2.556, 95%CI: 2.046-5.378, P=0.023].

Conclusion

In T2DM patients, elevated Lp(a) is an independent risk factor for CAHD and is associated with the severity of CAHD.

表1 T2DM患者CAHD组与non-CAHD组基本临床资料比较
表2 T2DM合并CAHD患者不同梗阻支数亚组间临床资料比较
表3 T2DM合并CAHD患者不同GS评分亚组间基本临床资料比较
表4 Lp(a)水平与CAHD严重程度的线性关系
表5 不同Lp(a)水平对CAHD发生风险及其严重程度的影响
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