| Aims: Patients with acute coronary syndrome(ACS)have diverse clinical manifestations,rapid disease changes,varying degrees of coronary artery lesions and hemodynamic changes,poor prognosis and high mortality.The morbidity and mortality of cardiovascular disease are higher in diabetic patients than in non-diabetic patients.The purpose of this study is to investigate the changes of plasma Lp(a)level and apolipoprotein A-I(ApoA-I)/apolipoprotein B(ApoB)ratio in patients with ACS complicated with type 2 diabetes and their clinical characteristics.Methods: We selected 376 cases of patients who diagnosed with ACS admitted to the first affiliated hospital of guangxi medical university from January 2013 to January 2019,all patients with coronary angiography examination,among them,173 cases combined with type 2 diabetes,153 cases not combined with type 2 diabetes.In addition,144 patients without type 2 diabetes whose coronary angiography is normal in the same period were selected as the control group.Record all of the patient’s demographic data,past history,smoking history,medication compliance,systolic pressure,diastolic blood pressure,heart rate,BMI,etc.After admission of fasting plasma glucose(FPG),2 h postprandial blood glucose(2 HPG),hemoglobin A1c(HbA1c),total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL-C),low density lipoprotein(LDL-C),lipoprotein(a)[Lp(a)],apolipoprotein A-I/apolipoprotein B(ApoA-I/ApoB)ratio,creatinine(SCr),fibrinogen(FIB),and other laboratory results and records patients electrocardiogram(ECG)and coronary angiography results.Comparing the difference between the three groups of patients with clinical parameters.The severity of coronary artery disease was quantitatively evaluated by Gensini integral according to CAG results,and was subdivided into a low score(0 ~ 51 points)and high score(≥52 points).All ACS patients received the acute coronary syndrome registration score(GRACE score),and been divided into three subgroups according to the GRACE score: low-risk group(108),medium-risk group(109~140)and high-risk group(> 140).The levels of Lp(a)and ApoA-I/ApoB ratio in the ACS group and the control group were analyzed to explore the correlation between Lp(a)and ApoA-I/ApoB ratio and the number of coronary artery lesions,coronary artery severity and risk.Results: 1.Compared with the control group,the proportion of males and smoking in the two ACS groups were higher,and the age,levels of FIB,HDL-C,LDL-C,ApoB,Lp(a)and non-HDL-C were significantly increased(P<0.05),and the ApoA-I/ApoB ratio decreased significantly(P<0.05),but the differences in the level of Lp(a)and the ApoA-I /ApoB ratio between the ACS groups were not statistically significant(P>0.05).2.In the ACS combined with type 2 diabetes mellitus group,the levels of Lp(a)in patients with multiple coronary artery lesions were significantly higher than those with single vessel lesions(P<0.05),the ApoA-I/ApoB ratio were lower than the double branch lesions and single lesion group(all P<0.05);in the ACS group without type 2 diabetes,the ApoA-I/ApoB ratio in coronary multiversity lesions and double branch lesions groups were lower than single lesion group(all P<0.05).3.In the ACS combined with type 2 diabetes mellitus group,compared with the patients with low Gensini score,the patients with high Gensini score had higher Lp(a)level and lower ApoA-I/ApoB ratio(P<0.05).However,the levels of Lp(a)and ApoA-I/ApoB ratio in the ACS group without type 2 diabetes showed no statistically significant differences among patients with different Gensini scores(P>0.05).4.In the ACS combined with type 2 diabetes mellitus group,the ApoA-I/ApoB ratio of high-risk GRACE patients was significantly lower than that of the low-risk and the medium-risk GRACE patients(P<0.05),and there was no significant difference in the level of Lp(a)among the three subgroups of GRACE score(P > 0.05).Lp(a)level and ApoA-I/ApoB ratio showed no difference among the three subgroups of GRACE score without type 2 diabetes mellitus(P>0.05).5.Compared with ACS without type 2 diabetes mellitus,patients with type 2 diabetes mellitus have a larger proportion of multi-vessel lesions(49.7% vs 35.3%,P<0.05),and have a higher Gensini score(65.31±41.82 vs 53.04±37.61,P<0.05).With the increase of Lp(a)level,the proportion of multi-vessel lesions in the group increased gradually(P<0.05).6.The result of correlation analysis.In the ACS group with type 2 diabetes mellitus,Lp(a)was positively correlated with the number of coronary artery lesions,Gensini score(r=0.212,r=0.166,all P<0.05),ApoA-I/ApoB ratio was negatively correlated with the number of coronary artery lesions,Gensini score(r=-0.160,r=-0.236,all P<0.05).In the ACS group without type 2 diabetes mellitus,the levels of Lp(a)and ApoA-I/ApoB ratio was unrelated to the number of coronary artery lesions,Gensini score(all P>0.05).Logistic regression analysis showed that increased of ApoA-I /ApoB ratio was the protective factor for multi-vessel lesions and the severe of coronary artery stenosis in patients with ACS complicated with type 2 diabetes(OR=0.415,OR=0.254,all P<0.05),and increased of Lp(a)was the risk factor for multi-vessel lesions(OR=1.009,P<0.05),but was ont the risk factor for the severe of coronary artery stenosis.7.the ApoA-I/ApoB ratio has a predictive of multi-vessel lesions and the severe of coronary artery stenosis in patients with ACS complicated with type 2 diabetes,the area under the ROC curve both are 0.643,With the ApoA-I/ApoB ratio of 1.050 as the standard,the sensitivity and specificity for the diagnosis of multi-vessel lesions of ACS complicated with type 2 diabetes were 59.8% and 65.1%,respectively,the sensitivity and specificity for the diagnosis of the severe of coronary artery stenosis of ACS complicated with type 2 diabetes were 59.8% and 65.1%,respectively.Conclusion: 1.ACS patients with type 2 diabetes have a higher proportion of severe coronary artery disease and multiple vessels than those without type 2 diabetes.2.The degree of coronary artery stenosis in ACS patients with type 2 diabetes was positively correlated with Lp(a)level,and negatively correlated with ApoA-I/ApoB ratio.Increased of ApoA-I /ApoB ratio was the protective factor for multi-vessel lesions and the severe of coronary artery stenosis in patients with ACS complicated with type 2 diabetes,and increased of Lp(a)was the risk factor for multi-vessel lesions.3.ApoA-I/ApoB ratio is of certain value in the prediction of multi-vessel lesions and the severe of coronary artery stenosis in patients with ACS complicated with type 2 diabetes. |
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