切换至 "中华医学电子期刊资源库"
高级检索
中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2020, Vol. 06 ›› Issue (02) : 91 -95. doi: 10.3877/cma.j.issn.2095-9605.2020.02.004

所属专题： 文献；

论著

脂蛋白a与糖尿病患者PCI术后他汀类药物治疗的临床结局的关系研究
张国奇1,†(), 黄超龙1, 陈素敏1   
  1. 1. 511500　清远，广州医科大学附属第六医院·清远市人民医院心血管内科
  • 收稿日期:2020-03-08 出版日期:2020-05-30
  • 通信作者: 张国奇

A study on the relationship between lipoprotein a and the clinical outcome of statin therapy in patients with diabetes after PCI.

Guoqi Zhang1,†(), Chaolong Huang1, Sumin Chen1   

  1. 1. Department of Cardiology, the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan 511500 China
  • Received:2020-03-08 Published:2020-05-30
  • Corresponding author: Guoqi Zhang
  • About author:
    Correspongding author: Zhang Guoqi, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

张国奇, 黄超龙, 陈素敏. 脂蛋白a与糖尿病患者PCI术后他汀类药物治疗的临床结局的关系研究[J]. 中华肥胖与代谢病电子杂志, 2020, 06(02): 91-95.

Guoqi Zhang, Chaolong Huang, Sumin Chen. A study on the relationship between lipoprotein a and the clinical outcome of statin therapy in patients with diabetes after PCI.[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2020, 06(02): 91-95.

目的

探讨Lp(a)与糖尿病患者PCI术后他汀类药物治疗的临床结局的关系。

方法

回顾性分析于2015年1月至2018年12月在广州医科大学附属第六医院经确诊为冠心病患者316例，根据纳入研究病例的Lp(a)水平，将患者分为高Lp(a)组和低Lp(a)组，对比两组患者的血压、糖化血红蛋白（HbA1c）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、超敏C反应蛋白（hsCRP）、氨基末端脑钠素前体(NT-proBNP)、左心射血分数（LVEF）水平，及用药情况，分析两组随访主要不良心脏事件（MACE）的发生情况。

结果

两组的收缩压、舒张压、HbA1c、TG、HDL-C、hsCRP、NT-proBNP、LVEF对比差异均无统计意义(P>0.05)，而高Lp(a)组的LDL-C水平显著高于低Lp(a)组，差异具有统计学意义（P<0.001）；两组患者阿司匹林、Β受体阻滞剂、CCB类、ACEI/ARB类药物用药情况的比例对比差异均无统计学意义（P>0.05）。高Lp(a)组的MACE发生率显著高于低Lp(a)组，差异具有统计学意义（HR：2.07，95%CI：1.281-3.542，P= 0.027）。

结论

PCI后接受他汀类药物治疗的糖尿病患者中血清高Lp(a)水平是不良心脏事件发生的独立风险因素。

关键词: 糖尿病, 脂蛋白a, PCI, 他汀, 不良心脏事件
Objective

To explore the relationship between Lp(a) and clinical outcomes of statin therapy in diabetic patients after PCI.

Methods

A retrospective analysis of 316 patients diagnosed with coronary heart disease from January 2015 to December 2018 in our hospital was divided into high Lp(a) group and low Lp(a) group according to the Lp(a) level of the included cases. Blood pressure, glycated hemoglobin (HbA1c), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), hypersensitive C-reactive protein (HsCRP), N-termina pro-brain natriuretic pep- tide(NT-proBNP), left ventricular ejection fraction (LVEF) levels were compared between the two groups, and medications were used to analyze the occurrence of major adverse cardiac events (MACE) during follow-up in both groups.

Results

There was no statistically significant difference in systolic blood pressure, diastolic blood pressure, HbA1c, TG, HDL-C, hsCRP, NT-proBNP, LVEF between the two groups (P>0.05), while the LDL-C level in the high Lp(a) group was significantly higher In the low Lp(a) group, the difference was statistically significant (P<0.001); the proportion of patients with aspirin, beta-blocker, CCB, ACEI/ARB medications in the two groups had no statistically significant differences in proportions (P>0.05). The incidence of MACE in the high Lp(a) group was significantly higher than that in the low Lp(a) group, and the difference was statistically significant (HR: 2.07, 95% CI: 1.281-3.542, P= 0.0057).

Conclusions

Serum high Lp(a) levels in diabetic patients receiving statin therapy after PCI are independent risk factors for adverse cardiac events.

Key words: Diabetes, Lipoprotein a, PCI, Statin, Adverse cardiac events
表1 两组患者的一般资料对比
组别 N（例） 年龄（岁） 性别（男/女） BMI（kg/m2） 高血压（%） 吸烟 冠心病家族史（%）
高Lp(a)组 158 60.2±5.6 104/54 24.2±1.8 114(72.2) 36(22.8) 24(15.2)
低Lp(a)组 158 59.1±5.1 100/58 23.9±2.2 122(77.2) 34(21.5) 19(12.0)
t/χ2值 ? 1.825 0.221 1.327 1.071 0.073 0.673
P值 ? 0.069 0.638 0.186 0.301 0.786 0.412
表2 不同Lp(a)水平与临床指标的关系
指标 高Lp(a)组（n=158） 低Lp(a)组（n=158） t/χ2值 P值
收缩压（mmHg） 137.2±24.1 138.2±23.9 0.370 0.711
舒张压（mmHg） 73.6±12.3 73.2±11.5 0.299 0.765
HbA1c（%） 7.2±1.0 7.3±1.1 0.846 0.398
TG（mg/dL） 139.2±43.6 146.7±47.3 1.465 0.144
HDL-C（mg/dL） 42.4±7.6 43.1±8.8 0.757 0.450
LDL-C（mg/dL） 109.4±17.4 94.5±16.3 7.855 <0.001
hsCRP（mg/L） 1.8±0.4 1.7±0.6 1.743 0.082
NT-proBNP（pg/ml） 485.5±42.4 480.8±46.4 0.940 0.348
LVEF（%） 45±4.7 44±4.5 1.159 0.247
用药情况（%） ? ? ? ?
阿司匹林 154（97.5） 150（94.9） 1.386 0.239
Β受体阻滞剂 82（51.9） 78（49.4） 0.203 0.653
CCB 67（42.4） 63（39.9） 0.209 0.647
ACEI/ARB 87（55.1） 83（52.5） 0.204 0.652
图1 不同Lp(a)水平对糖尿病患者PCI术后他汀类药物治疗后其MACE发生率的影响
[1]
Schwartz GG, Ballantyne CM, Barter PJ, et al. Association of Lipoprotein(a) with risk of recurrent ischemic events following acute coronary syndrome: analysis of the dal-outcomes randomized clinical trial[J]. JAMA Cardiology, 2018, 3(2): 164-168.
[2]
Tsimikas S. A Test in Context: Lipoprotein(a): Diagnosis, Prognosis, Controversies, and Emerging Therapies[J]. Journal of the American College of Cardiology, 2017, 69(6): 692-711.
[3]
Yang Q, He YM, Cai DP, et al. Risk burdens of modifiable risk factors incorporating lipoprotein (a) and low serum albumin concentrations for first incident acute myocardial infarction[J]. Scientific Reports, 2016, 6: 35463.
[4]
Hartmann M, von Birgelen C, Mintz GS, et al. Relation between lipoprotein(a) and fibrinogen and serial intravascular ultrasound plaque progression in left main coronary arteries[J]. Journal of the American College of Cardiology, 48(3): 446-452.
[5]
Hohenstein B, Julius U, Lansberg P, et al. Rationale and design of multiselect: a european multicenter study on the effect of lipoprotein(a) elimination by lipoprotein apheresis on cardiovascular outcomes[J]. Atherosclerosis Supplements, 2017, 30: 180-186
[6]
Huang Y. Establishing age and sex-dependent upper reference limits for the plasma lipoprotein (a) in a Chinese health check-up population and according to its relative risk of primary myocardial infarction[J]. Clinica Chimica Acta, 2019, 496: 140.
[7]
沈卫峰, 张奇, 张瑞岩, 等. 2015年急性st段抬高型心肌梗死诊断和治疗指南解析[J]. 国际心血管病杂志, 2015, 42(4): 217-219.
[8]
Oyd-Jones DM, Wilson PW, Larson MG, et al. Framingham risk score and prediction of lifetime risk for coronary heart disease[J]. American Journal of Cardiology, 2004, 94(1): 20-24.
[9]
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk[J]. European Heart Journal, 2020, 41(1): 111-188.
[10]
Maharjan P, Manandhar R, Xu W, et al. markers of autolysis in acute ST elevation myocardial infarction[J]. Journal of Nepal Medical Association, 2015, 53(198): 96-103.
[11]
Gragnano F, Fimiani F, Di Maio, et al. Impact of lipoprotein(a) levels on recur rent cardiovascular events in patients with premature coronary artery disease[J]. Internal and Emergency Medicine, 2019, 14(4): 621-625.
[12]
Konishi H, Miyauchi K, Shitara J, et al. Impact of lipoprotein(a) on long-term outcomes in patients with diabetes mellitus who underwent percutaneous coronary intervention[J]. American Journal of Cardiology, 2016, 118(12): 1781-1785.
[13]
Konishi H, Miyauchi K, Tsuboi S, et al. Plasma lipoprotein(a) predicts major cardiovascular events in patients with chronic kidney disease who undergo percutaneous coronary intervention[J]. International Journal of Cardiology, 2016, 205: 50-53.
[14]
Ling Y, Jiang J, Wu B, et al. Serum triglyceride, high-density lipoprotein cholesterol, apolipoprotein B, and coronary heart disease in a Chinese population undergoing coronary angiography[J]. Journal of Clinical Lipidology, 2017, 11(3): 646-656.
[15]
Park SH, Rha SW, Choi BG, et al. Impact of high lipoprotein(a) levels on in-stent restenosis and long-term clinical outcomes of angina pectoris patients undergoing percutaneous coronary intervention with drug-eluting stents in Asian population[J]. Clinical and Experimental Pharmacology and Physiology, 2015, 42(6):588-595.
[16]
Shapiro MD, Minnier J, Tavori H, et al. Relationship between low-density lipoprotein cholesterol and lipoprotein(a) lowering in response to PCSK9 inhibition with evolocumab[J]. Journal of the American Heart Association, 2019, 8: e10932.
[1] 何金梅, 尹立雪, 谭静, 张文军, 王锐, 任梅, 廖明娇. 超声心肌做功技术对2型糖尿病患者潜在左心室心肌收缩功能损伤的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1029-1035.
[2] 王珏, 陈赛君, 贲志飞, 詹锦勇, 徐开颖. 剪切波弹性成像联合极速脉搏波技术评估颈动脉弹性对糖尿病性视网膜病变的预测价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 636-641.
[3] 王洁, 丁泊文, 尹健. 糖尿病性乳腺病52例临床分析[J]. 中华乳腺病杂志(电子版), 2023, 17(05): 285-289.
[4] 陈絮, 詹玉茹, 王纯华. 孕妇ABO血型联合甲状腺功能检测对预测妊娠期糖尿病的临床价值[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 604-610.
[5] 张健, 刘小龙, 查天建, 姚俊杰, 王傑. 富含血小板血浆联合异种脱细胞真皮基质修复糖尿病足缺血性创面的临床效果[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 503-506.
[6] 赵雅玫, 谢斌, 陈艳, 吴健. 抗生素骨水泥联合负压封闭引流对糖尿病足溃疡临床疗效的荟萃分析[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 427-433.
[7] 叶弘, 吕婧喆, 钟良军. 白藜芦醇治疗牙周炎和糖尿病的新进展[J]. 中华口腔医学研究杂志(电子版), 2023, 17(05): 376-380.
[8] 李琛, 张惟佳, 潘亚萍. 牙周炎与系统性疾病之间关系的应用思考：2022年EFP和WONCA欧洲分部联合研讨会共识报告的解读及启示[J]. 中华口腔医学研究杂志(电子版), 2023, 17(05): 322-327.
[9] 王刚, 单伟根, 刘娟, 李长庆, 王新民. 常规治疗联合阿托伐他丁钙片对支气管扩张症临床分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 538-540.
[10] 李京珂, 张妍春, 武佳懿, 任秀瑜. 深度学习在糖尿病视网膜病变筛查、评级及管理中的研究进展[J]. 中华眼科医学杂志(电子版), 2023, 13(04): 241-246.
[11] 黄岩, 刘晓巍, 杨春玲, 兰烨. 急性胰腺炎合并糖尿病患者的临床特征及血糖代谢与病情严重度的相关性[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 439-442.
[12] 张政赢, 鞠阳, 刘晓宁. 二甲双胍对2型糖尿病患者大肠腺瘤术后复发的影响[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 485-488.
[13] 薛念余, 张盛敏, 吴凌恒, 沙蕾, 童揽月, 沈崔琴, 李朝军, 杜联芳. 研究血清胆红素对2型糖尿病患者心脏结构发生改变前心肌功能的影响[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1004-1009.
[14] 谭睿, 王晶, 於江泉, 郑瑞强. 脓毒症中高密度脂蛋白、载脂蛋白A-I和血清淀粉样蛋白A的作用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(06): 749-753.
[15] 谢国晓, 赵凌霞, 薛雪花. 慢性病管理模式在糖尿病社区管理中的应用[J]. 中华临床医师杂志(电子版), 2023, 17(05): 587-590.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号