Pedreño J, Fernández R, Ballester A, Jornet A, Usón M, Canela J, Petit M
Unitat de Recerca en Lípids i Arteriosclerosi, Universitat Rovira i Virgili, Facultat de Medicina, Sant Llorenç 21, 43201, Reus, Spain.
Int J Cardiol. 2000 Jul 31;74(2-3):159-67. doi: 10.1016/s0167-5273(00)00304-1.
Multiple studies have demonstrated that elevated serum lipoprotein (a) [Lp(a)] levels are independent predictors for coronary artery disease (CAD) in subjects without diabetes mellitus (DM). However, their contribution in patients with DM is controversial and still requires clarification. We determined serum Lp(a) levels in 355 consecutive Caucasian patients (271 men and 84 women) with angiographically documented CAD, and in 100 control subjects (58 men and 42 women) who were clinically free of cardiovascular disease. In addition, the association of serum Lp(a) levels with type-2 DM in patients with CAD was investigated after reassigning patients according to the diagnosis of type-2 DM (61 men and 40 women with type-2 DM and 210 men and 44 women without). No gender differences in Lp(a) levels were observed between men and women (patients and control subjects). Patients with CAD had higher Lp(a) levels than the control subjects (33 (14-74) vs. 13 (9-29) mg/dl, P<0.001). Elevated Lp(a) levels (defined as >90th percentile of controls) were significantly more prevalent in men and women with CAD (35% and 28%, respectively) than in control subjects (13% and 10%, respectively). Serum Lp(a) levels correlated with LDL cholesterol (r=0.22, P<0.001) and apo B levels (r=0.18, P<0.03) in patients and control subjects. Stepwise discriminant analysis revealed that Lp(a) was an independent risk factor for the presence of CAD, independent of smoking, hypertension, type-2 DM, LDL and HDL cholesterol or apo A1 and B levels. When patients were studied according to the spread of CAD (evaluated as the number of narrowed vessels), no differences in serum Lp(a) levels were observed, nor was there a higher prevalence of elevated Lp(a) levels. Finally, when patients were re-assigned according to the diagnosis of type-2 DM, no effect of apo B and LDL-C levels on Lp(a) was found (r=0.06, P=n.s. and 40.14, P=n.s., respectively) and serum Lp(a) levels neither associated nor contributed to the extent of CAD. Our results showed that serum Lp(a) levels are increased in patients with angiographically documented CAD, but there were no significant differences between diabetic and non-diabetic patients, which indicates that elevated Lp(a) levels are specifically associated with CAD but not with type-2 DM.
多项研究表明，血清脂蛋白(a)[Lp(a)]水平升高是无糖尿病(DM)受试者冠状动脉疾病(CAD)的独立预测因素。然而，其在糖尿病患者中的作用存在争议，仍需阐明。我们测定了355例经血管造影证实患有CAD的连续白种人患者(271例男性和84例女性)以及100例临床上无心血管疾病的对照受试者(58例男性和42例女性)的血清Lp(a)水平。此外，在根据2型糖尿病诊断重新分配患者后(61例男性和40例女性患有2型糖尿病，210例男性和44例女性未患2型糖尿病)，研究了CAD患者血清Lp(a)水平与2型糖尿病之间的关联。男性和女性(患者和对照受试者)之间未观察到Lp(a)水平的性别差异。CAD患者的Lp(a)水平高于对照受试者(33(14 - 74) vs. 13(9 - 29)mg/dl，P<0.001)。Lp(a)水平升高(定义为高于对照的第90百分位数)在患有CAD的男性和女性中(分别为35%和28%)比在对照受试者中(分别为13%和10%)显著更普遍。患者和对照受试者的血清Lp(a)水平与低密度脂蛋白胆固醇(r = 0.22，P<0.001)和载脂蛋白B水平(r = 0.18，P<0.03)相关。逐步判别分析显示，Lp(a)是CAD存在的独立危险因素，与吸烟、高血压、2型糖尿病、低密度脂蛋白和高密度脂蛋白胆固醇或载脂蛋白A1和B水平无关。当根据CAD的范围(评估为狭窄血管的数量)对患者进行研究时，未观察到血清Lp(a)水平的差异，Lp(a)水平升高的患病率也没有更高。最后，当根据2型糖尿病诊断重新分配患者时，未发现载脂蛋白B和低密度脂蛋白胆固醇水平对Lp(a)有影响(r = 0.06，P = 无统计学意义和r = 0.14，P = 无统计学意义)，血清Lp(a)水平与CAD的程度既无关联也无影响。我们的结果表明，经血管造影证实患有CAD的患者血清Lp(a)水平升高，但糖尿病患者和非糖尿病患者之间没有显著差异，这表明Lp(a)水平升高与CAD特异性相关，但与2型糖尿病无关。
