Amemiya H, Arinami T, Kikuchi S, Yamakawa-Kobayashi K, Li L, Fujiwara H, Hiroe M, Marumo F, Hamaguchi H
Division of Cardiology, Tsuchiura Kyodo General Hospital, Japan.
Atherosclerosis. 1996 Jun;123(1-2):181-91. doi: 10.1016/0021-9150(96)05806-6.
To evaluate whether a high level of lipoprotein(a) (Lp(a)) is a risk for the development of coronary heart disease (CHD), 94 Japanese patients and 64 age-matched Japanese controls, diagnosed after coronary angiography (CAG), were analyzed with special reference to the relations between the degree of atherosclerosis, Lp(a) levels and the apolipoprotein(a) (apo(a)) genotypes. the degree of atherosclerosis was evaluated based on CAG findings in the following three ways: the number of diseased vessels, the Gensini score, and the presence or absence of vascular ulcers and/or irregular outlines of coronary stenotic lesions. Apo(a) protein sizes and the pentanucleotide (TTTTA) repeat polymorphism in the 5' control region of the apo(a) gene were analyzed. Multivariate predictors for the number of diseased vessels were, in decreased order of significance, plasma Lp(a) levels, history of smoking, hypertension, diabetes mellitus, and body mass index (BMI). Independent factors associated with the Gensini score were Lp(a) levels, BMI, hypertension, and diabetes mellitus. A negative association of Lp(a) levels with apo(a) protein sizes, and higher Lp(a) levels in those homozygous for an allele with 8 8 (TTTTA)-repeats, was found in both the controls and patients. In decreasing order of significance, apo(a) protein sizes, the degree of atherosclerosis, the genotype of the pentanucleotide repeat, and gender were independent predictors of Lp(a) levels in stepwise regression models. Apo(a) protein sizes were a significant predictor, and the genotype homozygous for the 8 (TTTTA)-repeats was a possible predictor, for the degree of atherosclerosis in CHD. These findings support the notion that a high Lp(a) level is a risk for the development of atherosclerosis in CHD.
为评估高水平脂蛋白(a)[Lp(a)]是否为冠心病（CHD）发生的危险因素，对94例日本患者和64例年龄匹配的日本对照者进行了分析，这些患者和对照者均经冠状动脉造影（CAG）确诊，特别参考了动脉粥样硬化程度、Lp(a)水平与载脂蛋白(a)[apo(a)]基因型之间的关系。基于CAG结果，通过以下三种方式评估动脉粥样硬化程度：病变血管数量、Gensini评分以及血管溃疡和/或冠状动脉狭窄病变不规则轮廓的有无。分析了apo(a)蛋白大小以及apo(a)基因5'调控区的五核苷酸（TTTTA）重复多态性。病变血管数量的多变量预测因素按重要性递减顺序依次为血浆Lp(a)水平、吸烟史、高血压、糖尿病和体重指数（BMI）。与Gensini评分相关的独立因素为Lp(a)水平、BMI、高血压和糖尿病。在对照者和患者中均发现Lp(a)水平与apo(a)蛋白大小呈负相关，且等位基因8次（TTTTA）重复纯合子的Lp(a)水平较高。在逐步回归模型中，按重要性递减顺序，apo(a)蛋白大小、动脉粥样硬化程度、五核苷酸重复基因型和性别是Lp(a)水平的独立预测因素。apo(a)蛋白大小是CHD中动脉粥样硬化程度的重要预测因素，而8次（TTTTA）重复纯合子基因型可能是动脉粥样硬化程度的预测因素。这些发现支持了高Lp(a)水平是CHD中动脉粥样硬化发生危险因素这一观点。
