Lipoprotein (a) interactions with cholesterol-containing lipids on angiographic coronary collateralization in type 2 diabetic patients with chronic total occlusion
Lipoprotein (a) interactions with cholesterol-containing lipids on angiographic coronary collateralization in type 2 diabetic patients with chronic total occlusion
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脂蛋白 (a) 与含胆固醇脂质的相互作用对慢性完全闭塞 2 型糖尿病患者血管造影冠状动脉侧支化的影响
DOI：
10.1186/s12933-019-0888-z
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发表时间：
2019-06-24
影响因子：
9.3
通讯作者：
Shen, Wei Feng
中科院分区：
文献类型：
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作者：
Shen, Ying;Chen, Shuai;Shen, Wei Feng
背景我们研究了脂蛋白（a）[Lp（a）]与含胆固醇脂质的相互作用是否或在多大程度上与慢性完全闭塞的2型糖尿病患者的血管造影冠状动脉侧支化相关。对706例2型糖尿病和578例非糖尿病稳定型冠状动脉病变患者进行了冠状动脉造影检查，并测定了甘油三酯和非高密度脂蛋白胆固醇。从对侧血管供应完全闭塞远端的侧支循环程度被评为差（Rentrop评分为0或1）或冠状动脉侧支化良好结果对于糖尿病和非糖尿病患者，冠状动脉侧支化不良的患者的Lp（a）、总胆固醇、LDL-C和非HDL-C水平高于侧支化良好的患者，而HDL-C和甘油三酯水平相似。校正潜在混杂因素后，Lp（a）、总胆固醇、LDL-C和非HDL-C的三分位数仍然是不良抵押的独立决定因素。在糖尿病患者中观察到Lp（a）与总胆固醇、LDL-C和非HDL-C之间的显著交互作用（所有P交互作用< 0.001），而在非糖尿病患者中未观察到。在总胆固醇的高三分位数时（≥ 5.35 mmol/L），LDL-C（≥ 3.36 mmol/L）和非HDL-C（≥ 4.38 mmol/L），Lp（a）高三分位数的糖尿病患者（≥ 30.23 mg/dL）与Lp（a）低三分位组相比，（< 12.66 mg/dL）（校正OR值分别为4.300、3.970和4.386，P均< 0.001）。结论当总胆固醇、低密度脂蛋白胆固醇或非高密度脂蛋白胆固醇升高时，Lp（a）升高会增加冠状动脉侧支不良的风险，尤其是2型糖尿病患者。
BackgroundWe investigated whether or to what extent the interaction of lipoprotein (a) [Lp(a)] with cholesterol-containing lipids was associated with angiographic coronary collateralization in type 2 diabetic patients with chronic total occlusion.MethodsSerum levels of Lp(a), total cholesterol, low-density lipoprotein–cholesterol (LDL-C), high-density lipoprotein–cholesterol (HDL-C), and triglyceride were determined and non-HDL-C was calculated in 706 type 2 diabetic and 578 non-diabetic patients with stable coronary artery disease and angiographic total occlusion of at least one major coronary artery. The degree of collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded as poor (Rentrop score of 0 or 1) or good coronary collateralization (Rentrop score of 2 or 3).ResultsFor diabetic and non-diabetic patients, Lp(a), total cholesterol, LDL-C, and non-HDL-C levels were higher in patients with poor coronary collateralization than in those with good collateralization, whereas HDL-C and triglyceride levels were similar. After adjustment for potential confounding factors, tertiles of Lp(a), total cholesterol, LDL-C and non-HDL-C remained independent determinants for poor collateralization. A significant interaction between Lp(a) and total cholesterol, LDL-C or non-HDL-C was observed in diabetic patients (all P interaction < 0.001) but not in non-diabetics. At high tertile of total cholesterol (≥ 5.35 mmol/L), LDL-C (≥ 3.36 mmol/L) and non-HDL-C (≥ 4.38 mmol/L), diabetic patients with high tertile of Lp(a) (≥ 30.23 mg/dL) had an increased risk of poor collateralization compared with those with low tertile of Lp(a) (< 12.66 mg/dL) (adjusted OR = 4.300, 3.970 and 4.386, respectively, all P < 0.001).ConclusionsIncreased Lp(a) confers greater risk for poor coronary collateralization when total cholesterol, LDL-C or non-HDL-C are elevated especially for patients with type 2 diabetes.