2型糖尿病患者的脂蛋白(a)、载脂蛋白(a)多态性与冠状动脉粥样硬化严重程度

Lipoprotein(a), apolipoprotein(a) polymorphism and coronary atherosclerosis severity in type 2 diabetic patients.

作者信息

Gazzaruso C, Bruno R, Pujia A, De Amici E, Fratino P, Solerte S B, Garzaniti A

机构信息

IRCCS Maugeri Foundation Hospital Scientific Institue of Pavia, Italy.

出版信息

Int J Cardiol. 2006 Apr 14;108(3):354-8. doi: 10.1016/j.ijcard.2005.05.022. Epub 2005 Jun 14.

DOI:10.1016/j.ijcard.2005.05.022

PMID:15961173

Abstract

BACKGROUND

Few and conflicting data are available in the literature on the association between Lp(a) levels and the severity of coronary artery disease (CAD) in diabetic patients. In addition, no studies took into account the role of apo(a) polymorphism. The purpose of the present study was to analyse the association of the degree of coronary atherosclerosis with Lp(a) levels and apo(a) polymorphism in a large group of type 2 diabetic patients.

METHODS

The study population consisted of 227 consecutive type 2 diabetic patients undergoing a routine coronary angiography to evaluate chest pain or suspected CAD. The patients were subdivided into four subgroups according to the number of coronary arteries diseased: normal arteries (n=26), mono-vessel disease (n=67), bi-vessel disease (n=54) and multi-vessel disease (n=80).

RESULTS

Lp(a) levels (normal arteries: 14.6+/-19.6 mg/dl; mono-vessel disease: 19.0+/-16.4 mg/dl; bi-vessel disease: 19.3+/-15.1 mg/dl; multi-vessel disease: 26.5+/-16.8 mg/dl; p<0.001) and the percentages of patients with at least one isoform of low molecular weight (normal arteries: 23.1%; mono-vessel disease: 38.8%; bi-vessel disease: 75.9%; multi-vessel disease: 81.2%; p<0.001) were significantly correlated with increasing number of coronary vessels diseased. Multiple logistic regression analysis showed that both Lp(a) levels (OR: 1.31; 95% CI: 1.02-4.11) and apo(a) polymorphism (OR: 3.43; 95% CI: 1.67-7.05) were independent predictors of CAD severity.

CONCLUSIONS

Our data suggest that Lp(a) levels and apo(a) polymorphism may be reliable predictors of CAD severity in type 2 diabetic patients.

摘要

背景

关于糖尿病患者中脂蛋白(a)[Lp(a)]水平与冠状动脉疾病（CAD）严重程度之间的关联，文献中的数据较少且相互矛盾。此外，尚无研究考虑载脂蛋白(a)[apo(a)]多态性的作用。本研究的目的是分析一大组2型糖尿病患者中冠状动脉粥样硬化程度与Lp(a)水平及apo(a)多态性之间的关联。

方法

研究人群包括227例连续接受常规冠状动脉造影以评估胸痛或疑似CAD的2型糖尿病患者。根据病变冠状动脉的数量将患者分为四个亚组：正常动脉组（n = 26）、单支血管病变组（n = 67）、双支血管病变组（n = 54）和多支血管病变组（n = 80）。

结果

Lp(a)水平（正常动脉组：14.6±19.6mg/dl；单支血管病变组：19.0±16.4mg/dl；双支血管病变组：19.3±15.1mg/dl；多支血管病变组：26.5±16.8mg/dl；p<0.001）以及至少有一种低分子量异构体的患者百分比（正常动脉组：23.1%；单支血管病变组：38.8%；双支血管病变组：75.9%；多支血管病变组：81.2%；p<0.001）与病变冠状动脉数量的增加显著相关。多因素逻辑回归分析显示，Lp(a)水平（比值比：1.31；95%置信区间：1.02 - 4.11）和apo(a)多态性（比值比：3.43；95%置信区间：1.67 - 7.05）均为CAD严重程度的独立预测因素。