高敏C反应蛋白、脂蛋白(a)和同型半胱氨酸是日本外周动脉疾病患者冠状动脉疾病的危险因素。
High-sensitivity C-reactive Protein, Lipoprotein(a) and Homocysteine are Risk Factors for Coronary Artery Disease in Japanese Patients with Peripheral Arterial Disease.
作者信息
Kumakura Hisao, Fujita Kishu, Kanai Hiroyoshi, Araki Yoshihiro, Hojo Yoshiaki, Kasama Shu, Iwasaki Toshiya, Ichikawa Shuichi, Nakashima Kuniki, Minami Kazutomo
机构信息
Department of Internal Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital).
出版信息
J Atheroscler Thromb. 2015;22(4):344-54. doi: 10.5551/jat.25478. Epub 2014 Oct 8.
AIM
The goal of the study was to investigate the relationships between coronary artery disease (CAD) and risk factors, including the serum levels of high-sensitivity C-reactive protein (hs-CRP), lipoprotein(a) (Lp(a)) and homocysteine, in Japanese patients with peripheral arterial disease (PAD).
METHODS
Coronary angiography was performed in 451 patients with PAD, among whom the prevalence and clinical characteristics of CAD were analyzed. A multiple logistic analysis was used to evaluate the relationships between CAD and the risk factors. The relationships between the severity of coronary arterial lesions and the risk factors were evaluated using multiple regression analysis.
RESULTS
The prevalence of CAD (≥70% luminal diameter narrowing or a history of CAD) and coronary artery stenosis (≥50%) was 55.9% and 74.1%, respectively, and the rate of CAD (≥70%) with single-, double- and triple-vessel disease was 25.9%, 13.5% and 10.6%, respectively. The prevalence of diabetes was higher among the patients with CAD than among those without. The serum levels of hs-CRP, Lp(a), and homocysteine were higher in the patients with CAD, whereas the estimated glomerular filtration rates and HDL-cholesterol levels were lower in these patients. According to the multiple logistic analysis, CAD was related to diabetes (hazard ratio [HR]: 2.253; 95% confidence interval [CI]: 1.137-4.464, p=0.020), hs-CRP (HR: 1.721; 95% CI: 1.030-2.875, p=0.038), Lp(a) (HR: 1.015; 95% CI: 1.001-1.029, p=0.041) and homocysteine (HR: 1.084; 95% CI: 1.012-1.162, p=0.021). Furthermore, diabetes and the D-dimer and LDL-cholesterol levels exhibited significant relationships with the number of stenotic coronary lesions in the stepwise multiple regression analysis (p＜0.05).
CONCLUSIONS
Diabetes, hs-CRP, Lp(a), homocysteine and lipid abnormalities are critical risk factors for CAD in Japanese patients with PAD.
目的
本研究旨在调查日本外周动脉疾病（PAD）患者中冠状动脉疾病（CAD）与危险因素之间的关系，这些危险因素包括血清高敏C反应蛋白（hs-CRP）、脂蛋白（a）[Lp（a）]和同型半胱氨酸水平。
方法
对451例PAD患者进行冠状动脉造影，分析其中CAD的患病率和临床特征。采用多因素逻辑回归分析评估CAD与危险因素之间的关系。使用多元回归分析评估冠状动脉病变严重程度与危险因素之间的关系。
结果
CAD（管腔直径狭窄≥70%或有CAD病史）和冠状动脉狭窄（≥50%）的患病率分别为55.9%和74.1%，单支、双支和三支血管病变的CAD（≥70%）发生率分别为25.9%、13.5%和10.6%。CAD患者中糖尿病的患病率高于无CAD患者。CAD患者的hs-CRP、Lp（a）和同型半胱氨酸血清水平较高，而这些患者的估计肾小球滤过率和高密度脂蛋白胆固醇水平较低。根据多因素逻辑回归分析，CAD与糖尿病（风险比[HR]：2.253；95%置信区间[CI]：1.137 - 4.464，p = 0.020）、hs-CRP（HR：1.721；95% CI：1.030 - 2.875，p = 0.038）、Lp（a）（HR：1.015；95% CI：1.001 - 1.029，p = 0.041）和同型半胱氨酸（HR：1.084；95% CI：1.012 - 1.162，p = 0.021）有关。此外，在逐步多元回归分析中，糖尿病、D-二聚体和低密度脂蛋白胆固醇水平与冠状动脉狭窄病变数量呈显著关系（p＜0.05）。
结论
糖尿病、hs-CRP、Lp（a）、同型半胱氨酸和脂质异常是日本PAD患者发生CAD的关键危险因素。
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