The Correlation Study Of Lipoprotein(a),Homocysteine Levels And Severity Of Coronary Artery Disease In Patients With Coronary Artery Disease

Objective:To explore the correlation between the levels of lipoprotein(a)and homocysteine and the severity of coronary artery disease in patients with coronary heart disease,for providing a reference for clinical doctors to predict the severity of coronary artery disease.Methods:A total of 380 patients with chest discomfort and/or clinically suspected coronary artery disease in the Department of Cardiovascular Surgery of Shanxi Provincial People’s Hospital from September 2020 to September 2022 were included.According to the inclusion and exclusion criteria,200 patients were finally selected as the coronary heart disease group.And another 30 patients were selected for coronary artery disease in the same period.Angiography(Coronary angiography,CAG)examination showed that patients with no significant coronary artery stenosis were retrospectively studied as the control group.The basic information(gender,age,body mass index,history of hypertension,diabetes,smoking,drinking,etc.),clinical test indicators(triglycerides,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol)of the two groups of patients were collected.Lipoprotein cholesterol,homocysteine??(Homocysteine,HCY),lipoprotein a(Lipoprotein(a),LP(a)),etc.).The SYNTAX score is composed of the sum of the stenosis score and the lesion characteristic score,which can be used to evaluate the severity of coronary artery lesions.By comparing the differences in the SYNTAX score,stenosis score,and lesion characteristic scores of each group,it can be used to explore the lipoprotein a and isotype of patients with coronary heart disease.Correlation between cysteine??levels and severity of coronary artery lesions.According to the SYNTAX scoring standard,the low-risk group(0-22 points),the intermediate-risk group(23-32 points),and the high-risk group(≥ 33 points)were divided into groups;according to the HCY level(0-15 umol/L is normal,>15 umol/L is elevated),LP(a)level(0-300mg/L is normal,>300mg/L is elevated)divided into normal HCY and LP(a)group,only HCY elevated group,only LP(a)Elevated group,HCY and LP(a)both elevated group.SPSS 26.0 statistical software was used for data processing and analysis.The differences in HCY and LP(a)levels were compared between the CAD group and the control group and between the low,medium and high risk groups with SYNTAX scores,and the correlations between blood HCY and LP(a)levels and SYNTAX scores,stenosis scores and lesion characteristics scores,HCY,LP(a)value of predicting the severity of coronary artery disease.To explore the correlation between HCY,LP(a)levels and the severity of coronary artery disease in patients with coronary heart disease.Results:(1)Compared with the blood LP(a)level [136.70(91.94,146.69)mg/L] and HCY level(7.03±2.05umol/L)in the control group(n=30),the blood level of the CAD group(n=200)The level of LP(a)[256.19(145.35,468.13)mg/L] and the level of HCY(14.45±7.36 umol/L)increased,and the difference was statistically significant(P<0.05).(2)The blood LP(a)level and HCY level among the subgroups grouped according to the SYNTAX score were high-risk group [710.47(670.36,731.62)mg/L 、 24.29 ± 8.80umol/L]>intermediate-risk group [450.98(308.64,653.65)mg/L、20.78±4.98umol/L]>low-risk group [182.21(119.32,262.62)mg/L、10.23±4.46umol/L],the difference was statistically significant(P<0.05).(3)The SYNTAX score,stenosis score,and lesion feature score of both LP(a)and HCY elevated groups were compared with those of only LP(a)elevated group,only HCY elevated group,and normal LP(a)and HCY group significantly increased(P <0.05).(4)Multiple linear regression analysis showed that after adjusting confounding factors,blood HCY and LP(a)levels were still independently correlated with SYNTAX score,stenosis score,and lesion characteristic score(P<0.05).(5)The area under the ROC curve of ROC curve HCY,LP(a)and LP(a)+HCY joint detection were0.899(95%CI:0.857-0941)、0.933(95%CI:0.899-0.967)、0.954(95%CI:0.925-0.982),the diagnostic sensitivity and specificity were 0.816、0.842、0.868 and 0.855、0.903、0.935,compared with the single detection of the two indicators,the sensitivity and specificity of the joint detection were both increased(P<0.05).Conclusion:The blood HCY and LP(a)levels in the CAD group were positively correlated with the SYNTAX score,the higher the blood HCY and LP(a)levels in the CAD group,the more severe the coronary artery disease was.And the two have a synergistic effect in the process of affecting coronary atherosclerosis,suggesting that the detection of blood HCY and LP(a)in CAD patients has a certain clinical value,which can provide a theoretical basis for clinical prevention and treatment of coronary heart disease.