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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:
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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
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