Hoff H F, Beck G J, Skibinski C I, Jürgens G, O'Neil J, Kramer J, Lytle B
Department of Brain, Research, Cleveland Clinic Foundation, OH 44106.
Circulation. 1988 Jun;77(6):1238-44. doi: 10.1161/01.cir.77.6.1238.
Although the serum lipoprotein fraction Lp(a) has been associated with coronary artery atherosclerosis, its relationship to narrowing of saphenous vein grafts has not previously been elucidated. We therefore measured serum Lp(a) levels in 167 symptomatic patients undergoing cardiac catheterization who had had coronary artery bypass surgery 0.7 to 14.3 years earlier. Lp(a), total cholesterol, and total triglyceride levels were compared with the degree of saphenous vein graft stenosis to test for any association. Serum Lp(a) levels were significantly associated with the degree of stenosis of saphenous vein grafts (r = .24, p = .002). Mean Lp(a) levels (mg/dl) in the 135 patients with stenosis were almost double (32.0 +/- 32.7, mean +/- SD) those in the 32 patients with no graft stenosis (16.7 +/- 22.6; p = .002). Graft stenosis was not associated with previous myocardial infarction, hypertension, obesity, diabetes, or smoking. Serum cholesterol levels (mg/dl) were slightly higher in the stenosis group (251.3 +/- 69) than in the no-stenosis group (231.8 +/- 48.8), but the difference was of borderline significance (p = .06). A stepwise increase in mean Lp(a) was found in groups of patients with increasing vein graft stenosis. At a serum Lp(a) level of 31.6 mg/dl or above, 92% of the patients demonstrated vein graft stenosis. Thus, patients with elevated Lp(a) levels have an increased risk of developing saphenous vein graft stenosis after coronary bypass surgery.
尽管血清脂蛋白组分Lp(a)与冠状动脉粥样硬化有关，但其与隐静脉移植血管狭窄的关系此前尚未阐明。因此，我们测量了167例有症状且接受心导管检查的患者的血清Lp(a)水平，这些患者在0.7至14.3年前接受了冠状动脉搭桥手术。将Lp(a)、总胆固醇和总甘油三酯水平与隐静脉移植血管狭窄程度进行比较，以检测是否存在关联。血清Lp(a)水平与隐静脉移植血管狭窄程度显著相关（r = 0.24，p = 0.002）。135例有狭窄的患者的平均Lp(a)水平（mg/dl）几乎是32例无移植血管狭窄患者的两倍（32.0±32.7，平均值±标准差）（16.7±22.6；p = 0.002）。移植血管狭窄与既往心肌梗死、高血压、肥胖、糖尿病或吸烟无关。狭窄组的血清胆固醇水平（mg/dl）略高于无狭窄组（251.3±69），但差异具有临界显著性（p = 0.06）。在隐静脉移植血管狭窄程度增加的患者组中发现平均Lp(a)呈逐步升高。当血清Lp(a)水平达到31.6 mg/dl或更高时，92%的患者出现隐静脉移植血管狭窄。因此，Lp(a)水平升高的患者在冠状动脉搭桥手术后发生隐静脉移植血管狭窄的风险增加。
