目的：探讨血清脂蛋白（a）〔Lp（a）〕水平与稳定性冠心病的关系及他汀类药物治疗后患者 Lp（a）水平及血脂指标变化特点。方法收集2011年4月—2014年1月在上海市浦东新区金杨社区卫生服务中心长期就诊，经临床确诊符合2007年《中国成人血脂异常防治指南》中需要他汀类药物治疗的血脂异常患者144例为血脂异常组、稳定性冠心病患者99例为稳定性冠心病组，计算机随机数字表法抽取同期本社区中无高血压、糖尿病、心脑血管疾病病史且未接受过他汀类药物治疗的体检健康者136例为对照组，血脂异常组和稳定性冠心病组患者给予阿托伐他汀片规则治疗1年，血脂异常组和稳定性冠心病组患者于治疗前，治疗后1个月、3个月、1年和对照组受试者于体检时及1年后检测血清 Lp（a）及血脂指标水平。结果3组间性别、年龄、腰臀比比较，差异无统计学意义（ P >0.05）；稳定性冠心病组患者体质指数（BMI）高于对照组（P <0.05）；血脂异常组和稳定性冠心病组患者收缩压、舒张压高于对照组（P <0.05）。治疗前血脂异常组和稳定性冠心病组患者 Lp（a）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）水平高于对照组（P <0.05）；稳定性冠心病组患者 Lp（a）水平高于血脂异常组，TC、LDL-C 水平低于血脂异常组（P <0.05）；稳定性冠心病组患者高密度脂蛋白胆固醇（HDL-C）水平低于血脂异常组和对照组（P <0.05）。对照组1年后 Lp（a）水平与基线时比较，差异无统计学意义（P >0.05）。血脂异常组与稳定性冠心病组患者治疗前后 Lp（a）、LDL-C 水平比较，不存在交互作用（P >0.05）；TC、HDL-C、TG 水平比较，治疗方法与时间存在交互作用（ P <0.05）；Lp（ a）、TC、LDL-C、TG 水平组间比较，差异有统计学意义（ P <0.05）；Lp（a）、TC、LDL-C 水平时间间比较，差异有统计学意义（P <0.05）。治疗前，对照组、血脂异常组、稳定性冠心病组Lp（a）水平与 TC、LDL-C、HDL-C、TG 水平均无直线相关关系（| r |<0.300）；对照组、血脂异常组、稳定性冠心病组治疗前、治疗后1年 Lp（ a）水平变化与 TC、LDL-C、HDL-C、TG 水平变化均无直线相关关系（| r |<0.300）。结论稳定性冠心病患者 Lp（a）水平高于血脂异常患者和体检健康者，Lp（a）水平与冠心病关系密切；Lp（a）与其他血脂指标无相关性；他汀类药物治疗后，稳定性冠心病患者 Lp（a）水平未明显下降，他汀类药物对Lp（a）水平无明确影响。%Objective To investigate the relationship between lipoprotein(a)〔Lp(a)〕level and stable coronary artery disease ( CAD) and the changing characteristics of Lp ( a) level and other serum lipid parameters after statins therapy. Methods A total of 144 patients were assigned into dyslipidemia group and 99 patients were assigned into stable CAD group;the above patients were definitely diagnosed as conforming to the standard of receiving statins therapy of 2007 Guidelines on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults and received long - term treatment in Jinyang Community Health Service Center in Shanghai Pudong New Area from April 2011 to January 2014. A total of 136 healthy persons without medical history of hypertension,diabetes and cardiovascular and cerebrovascular diseases and statins treatment were enrolled from the same community as control group using computer random number table. Dyslipidemia group and stable CAD group were given regular treatment with atorvaststin for a year;the level of serum Lp(a)and blood lipid levels of dyslipidemia group and stable CAD group were detected before treatment and after one month,three months and one year treatment;the serum Lp(a)and blood lipid index levels of control group were detected during physical examination and one year later. Results No significant difference existed in gender,age and waist hip ratio among the three groups( P > 0. 05);the body mass index (BMI)of stable CAD group was higher than that of the control group(P < 0. 05);systolic pressure and diastolic blood pressure of dyslipidemia group and stable CAD group were higher than those of control group(P < 0. 05). Lp( a),total cholesterol (TC),low density lipoprotein cholesterin( LDL-C) and triacylglycerol( TG) levels of dyslipidemia group and stable CAD group before treatment were higher than those of control group(P < 0. 05). Lp(a)level of stable CAD group was higher than that of dyslipidemia group(P < 0. 05);TC and LDL-C levels of stable CAD group were lower than those of dyslipidemia group (P < 0. 05);high density lipoprotein cholesterol(HDL-C)level of stable CAD group was lower than that of dyslipidemia group and control group(P < 0. 05). Lp(a)level of control group one year later was not significantly different from the baseline level (P > 0. 05). The comparison of Lp(a)and LDL-C level between dyslipidemia group and stable CAD group before and after treatment showed no interaction effect( P > 0. 05);the comparison of TC,HDL-C and TG levels showed interaction effect between therapeutic method and time(P < 0. 05);significant differences existed in the levels of Lp(a),TC,LDL-C and TG among the three groups(P < 0. 05);significant differences existed in the levels of Lp(a),TC and LDL-C among different time points( P < 0. 05) . Before treatment,Lp( a)level and the levels of TC,LDL-C,HDL-C and TG had no linear correlation in the three groups( | r | < 0. 300);the change of Lp(a)level had no linear correlation with the changes of the levels of TC,LDL-C,HDL-C and TG in the three groups after one - year treatment( | r | < 0. 300). Conclusion Lp(a) level of stable CAD patients is higher than that of dyslipidemia patients and healthy people by physical examination,and Lp(a) level is closely related to CAD;Lp(a)level has no correlation with other serum lipid parameters. The Lp(a)level of patients with stable CAD has no marked decline after statins therapy;the effect of statins on Lp(a)level is undefined.
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