[脂蛋白（a）与原发性高胆固醇血症中的动脉粥样硬化相关]

[Lipoprotein(a) is associated to atherosclerosis in primary hypercholesterolemia].

作者信息

Bea Ana M, Mateo-Gallego Rocío, Jarauta Estíbaliz, Villa-Pobo Rosa, Calmarza Pilar, Lamiquiz-Moneo Itziar, Cenarro Ana, Civeira Fernando

机构信息

Unidad de Lípidos y Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, España.

Instituto Aragonés de Ciencias de la Salud, Hospital Universitario Miguel Servet, Zaragoza, España.

出版信息

Clin Investig Arterioscler. 2014 Jul-Aug;26(4):176-83. doi: 10.1016/j.arteri.2014.01.001. Epub 2014 Feb 25.

DOI:10.1016/j.arteri.2014.01.001

PMID:24576773

Abstract

INTRODUCTION

Several studies have suggested that Lp(a) could be a risk factor mainly in hypercholesterolemic patients.

METHODS

A total of 909 individuals were selected for this study. 307 were diagnosed of familiar hypercholesterolemia with a pathogenic mutation in LDLR or APOB genes (FH+), 291 of familiar combined hyperlipidemia (FCH) and 311 of familial hypercholesterolemia without a pathogenic mutation in LDLR nor APOB genes (FH-). Main risk factor were studied, included statin treatment. Plasma lipids, Lp(a), HbA1c and C-reactive protein. Intima-media thickness (IMT) of common and bulb carotid in both sides were measured in all subjects.

RESULTS

Lp(a) values (median, interquartile range) were 21.9mg/dL (9.24-50.5) in FH+, 22.4mg/dL (6.56-51.6) in FCH and 32.7 (14.6-71.5) in FH- (P<.001). Regression analysis including age, gender, HDL cholesterol, LDL cholesterol corrected for Lp(a), Lp(a), C-reactive protein, packs of cigarettes/day per year, systolic blood pressure and glucose as independent variables, demonstrate that Lp(a) was associated with carotid IMT in FH- subjects. Cardiovascular disease was more frequent in subjects with Lp(a) >50mg/dL (17.9%) than in subjects with Lp(a) <15mg/dL (9.6%), and between 15-50mg/dL (10.1%), and it was concentrated mostly in FH-group (6.7, 11.3, and 23.4% for the groups of Lp(a) <15mg/dL 15-50mg/dL, and >50mg/dL, respectively).

CONCLUSIONS

Our results indicate that Lp(a) is associated with atherosclerosis burden especially in subjects with FH- and concentrations of Lp(a)>50mg/dL.

摘要

引言

多项研究表明，脂蛋白(a)[Lp(a)]可能主要是高胆固醇血症患者的一个风险因素。

方法

本研究共选取了909名个体。其中307名被诊断为家族性高胆固醇血症且低密度脂蛋白受体(LDLR)或载脂蛋白B(APOB)基因存在致病性突变(FH+)，291名患有家族性混合性高脂血症(FCH)，311名患有家族性高胆固醇血症但LDLR和APOB基因均无致病性突变(FH-)。研究了主要风险因素，包括他汀类药物治疗。检测了血浆脂质、Lp(a)、糖化血红蛋白(HbA1c)和C反应蛋白。测量了所有受试者双侧颈总动脉和颈动脉球部的内膜中层厚度(IMT)。

结果

FH+组Lp(a)值(中位数，四分位间距)为21.9mg/dL(9.24 - 50.5)，FCH组为22.4mg/dL(6.56 - 51.6)，FH-组为32.7(14.6 - 71.5)(P<0.001)。回归分析将年龄、性别、高密度脂蛋白胆固醇、校正Lp(a)后的低密度脂蛋白胆固醇、Lp(a)、C反应蛋白、每年吸烟包数、收缩压和血糖作为自变量，结果表明在FH-受试者中Lp(a)与颈动脉IMT相关。Lp(a)>50mg/dL的受试者心血管疾病发生率(17.9%)高于Lp(a)<15mg/dL的受试者(9.6%)以及Lp(a)在15 - 50mg/dL之间的受试者(10.1%)，且主要集中在FH-组（Lp(a)<15mg/dL、15 - 50mg/dL和>50mg/dL组的发生率分别为6.7%、11.3%和23.4%）。