摘要
目的 评价脂蛋白 (a)及其联合其他血脂指标对冠心病的诊断价值。方法 分析 6 38例怀疑冠心病患者 (其中经冠状动脉造影确诊的冠心病 4 10例 ,非冠心病 2 2 8例 )的临床资料 ,用标准方法检测血脂水平 ,比较各个血脂指标的诊断价值。结果 冠心病患者的血清总胆固醇 [(5 .0± 1.2 )mmol/L]、低密度脂蛋白胆固醇 [(LDL C) (3.0± 1.0 ) ]mmol/L、脂蛋白 (a) [(2 6 0± 2 2 6 )mg/L]水平及总胆固醇与高密度脂蛋白胆固醇 (HDL C)的比值 (5 .2± 2 .0 )显著高于非冠心病患者 [(4 .6± 1.1)mmol/L ,(2 .6± 0 .9)mmol/L ,(192± 174 )mg/L ,4 .5± 1.5 ,P≤ 0 .0 0 1],HDL C水平 [(1.0± 0 .3)mmol/L]明显低于非冠心病患者 [(1.1± 0 .3)mmol/L ,P =0 .0 4 5 ],而两组间其他血脂水平差异无统计学意义。冠心病患者中 ,血清总胆固醇、LDL C、脂蛋白 (a)及总胆固醇与HDL C比值的异常率显著高于非冠心病患者 ,其他血脂指标的异常率在两组无明显差别。脂蛋白 (a)对冠心病的预测值及似然比并不优于其他血脂指标 ,联合LDL C可提高阳性预测值及似然比。在logstic多元回归中 ,冠心病的危险性与传统的危险因素均呈正相关 ,脂蛋白 (a)与冠心病的相关性不优于其他指标。结论 脂蛋白p(a)
Objective To evaluate the diagnostic value of lipoprotein(a), serum lipids and their combination in coronary heart disease(CHD). Methods 638 patients with suspected CHD were enrolled into this study, who were divided into two groups according to the result of coronary arterography: ①CHD group(n=410) and ② non-CHD group(n=228). Their clinical data were analysed by case-control method, and serum lipids were detected by standard method.Results The levels of serum total cholesterol[( 5.0± 1.2) mmol/L], low density lipoprotein cholesterol[( 3.0± 1.0) mmol/L], lipoprotein(a)[(260±226) mg/L] and the ratio of total cholesterol to high density lipoprotein cholesterol( 5.2± 2.0) in CHD group significantly raised (P≤ 0.001), compared with non-CHD group[( 4.6± 1.1) mmol/L,( 2.6± 0.9) mmol/L,(192±174) mg/L, 4.5± 1.5], whereas the level of high density lipoprotein cholesterol[( 1.0± 0.3) mmol/L] of the former group was significantly lower than that of the latter group [( 1.1± 0.3) mmol/L] (P= 0.045). There was not significant difference in serum triglyceride level and triglyceride/high density lipoprotein cholesterol ratio between two groups. The abnormal rate of total cholesterol, low density lipoprotein cholesterol, lipoprotein(a) and total cholesterol/ high density lipoprotein cholesterol ratio in CHD group significantly increased, while the abnormal rate of other lipids did not significantly differ. The predicative value and likelihood ratio of lipoprotein(a) for CHD was not superior to that of other lipids, but when combined with low density lipoprotein cholesterol, the value would further be elevated. In logistic regression model, lipoprotein(a) was not more related to CHD risk than other lipids.Conclusion The diagnostic value of lipoprotein(a) is not better than other lipids, when combined with low density lipoprotein cholesterol, it may be regarded as a better predicative marker for CHD.
出处
《临床荟萃》
CAS
北大核心
2004年第17期963-966,共4页
Clinical Focus
