| Objective:Optical coherence tomography(OCT)was used to qualitatively and quantitatively analyze the atherosclerotic plaque in coronary artery of patients with coronary heart disease,and further explore the relationship between the level of Lp(a)and the rupture of coronary atherosclerotic plaque,so as to provide theoretical basis for the selection of clinical treatment plan.Methods:We selected 208 patients who were admitted to our hospital from January 2020 to December 2022 and were diagnosed with coronary artery disease by coronary angiography and underwent OCT examination as the study subjects.They were divided into three groups a ccording to disease type:myocardial infarction group(AMI)(n=92),unstable angina pectoris(UA)(n=37),stable angina pectoris(SA)(n=79).The general data and laboratory test results of the patients in the group were collected through the electronic medical record system of our hospital,the coronary angiography was improved,the diseased vessels were determined,and the condition of atherosclerotic plaque(lipid plaque,calcified plaque,microchannel,macrophage infiltration,cholesterol crystal,throm bus,plaque rupture,plaque erosion,etc.)at the culprit’s lesion was observed through OCT and measured and analyzed.Observe the distribution of Lp(a)level in different disease groups,analyze the distribution of atherosclerotic plaque in different gro ups according to the OCT results,and then divide them into plaque rupture group and non-rupture group according to whether the plaque is broken,and further explore the correlation between Lp(a)level and plaque rupture.The collected data were analyzed by IBM SPSS Statistical 27.0 statistical software,and the difference was statistically significant with P<0.05.Results: 1.This study included 208 patients with coronary heart disease,92 in AMI group,37 in UA group and 79 in SA group.The level of Lp(a)in AMI group was significantly higher than that in UA group and SA group(P<0.05).The distribution of other lipid indexes TC,TG,HDL-C and LDL-C in the three groups was not significantly different(P>0.05).Compared with SA group,the minimum lumen are a and the percentage of area stenosis in the diseased vessels in AMI group were smaller,and the difference was statistically significant(P<0.05).The detection rate of lipid plaque,thrombus,TCFA and plaque erosion in AMI group was higher than that in UA group(P<0.05).The detection rate of lipid plaque,cholesterol crystal,thrombus,TCFA,plaque rupture and plaque erosion in AMI group was significantly higher than that in SA group(P<0.05).Among the detected lipid plaques,the maximum lipid pool leng th and radian of AMI group were lower than those of UA and SA group,while the maximum lipid depth was lower than those of UA and SA group,with statistically significant difference(P<0.05).The thickness of fibrous cap plaque in AMI group was lower than that in UA and SA group,and the thickness of fibrous cap plaque in UA group was lower than that in SA group,the difference was statistically significant(P<0.05).There was no big difference in the length of lesion,calcified plaque,macrophage infi ltration and microchannel among the three groups(P>0.05).2.According to the results of OCT,the patients were divided into two groups:plaque rupture group(n = 82)and plaque unruptured group(n = 126).The levels of Lp(a)and LDL-C in plaque rupture group were significantly higher than those in plaque unruptured group.Compared with the group without plaque rupture,the white blood cell count and the prevalence of diabetes mellitus were higher and the level of HDL-C was lower in the plaque rupture group.There was no significant difference in neutrophils,monocytes,lymphocytes,erythrocytes,platelets,D-dimer,HCY,TC,TG,creatinine and uric acid between the two groups.3.Compared with the group without plaque rupture,the percentage of area stenosis,the length of the largest lipid pool and the radian of the largest lipid pool in the plaque rupture group were higher,and the difference was significant in statistics(P<0.05).The thickness of the thinnest fiber cap and the depth of the largest lipid pool in the plaque rupture group were significantly lower than those in the plaque non-rupture group(P<0.05).The detection rate of lipid plaque,macrophage infiltration,cholesterol crystal,thrombus and TCFA in plaque rupture group was sig nificantly higher than that in plaque non-rupture group(P<0.05).There was no significant difference between the two groups in lesion length,minimum lumen area,calcified plaque,microchannel,plaque erosion and other data(P>0.05).4.There was no signi ficant correlation between Lp(a)level and other lipid TC,TG,HDL-C,LDL-C(P>0.05).Lp(a)was positively correlated with plaque rupture,TCFA,plaque erosion,thrombus,cholesterol crystal,white blood cells and neutrophils(P<0.05).Lp(a)was negativ ely correlated with the minimum lumen area(P<0.05).5.The results of binary logistic univariate regression analysis showed that plaque rupture and Lp(a)(OR: 1.036,95% CI: 1.002-1.051,P<0.001),the existence of diabetes(OR: 1.846,95% CI: 1.005-3.392,P=0.048),white blood cells(OR: 1.090,95% CI: 1.001-1.187,P=0.047),HDL-C(OR: 0.233,95% CI: 0.069-0.785,P=0.019),LDL-C(OR: 1.410,95% CI: 1.007-1.976,P=0.046)Maximum lipid pool length(OR: 1.356,95% CI: 1.096-1.677,P=0.005),maximum lipid pool radian(OR: 1.012,95% CI: 1.005-1.019,P<0.001),maximum lipid pool depth(OR: 0.000,95% CI: 0.000-0.023,P<0.001),macrophage infiltration(OR: 1.847,95% CI: 1.0453.263,P=0.035),cholesterol crystallization(OR: 2.119,95% CI: 1.168-3.846,P=0.014)Thrombosis(OR: 9.052,95% CI: 4.577-17.902,P<0.001),TCFA(OR: 7.219,95% CI: 3.657-14.250,P<0.001),and the thickness of the thinnest fibrous cap plaque(OR: 0.000,95% CI: 0.000-0.000,P<0.001),which may be the risk factor of plaque rupture.6.Lp(a)is an independent risk factor for plaque rupture.The single factor Lp(a)of plaque rupture,diabetes,white blood cells,HDL-C,LDL-C,TCFA,the depth of the largest lipid pool,the radian of the largest lipid pool,the length of the largest lipid pool,macrophage infiltration,cholesterol crystallization,thrombosis,and the thickness of the thinnest fibrous cap plaque were included in the multifactor regression model.The results showed that HDL-C(OR: 0.136,95% CI: 0.022-0.824,P=0.030)Lp(a)(OR:1.041,95% CI: 1.023-1.060,P< 0.001),thrombus(OR: 5.940,95% CI:2.294-15.383,P < 0.001),and the thickness of the thinnest fibrous cap plaque(OR: 0.000,95% CI: 0.000-0.000,P = 0.002)are independently related to the occurrence of plaque rupture.Lp(a)(OR: 1.041,95% CI:1.023-1.060,P < 0.001)are independent of the classic risk factors of plaque rupture,and still independently related to the occurrence of plaque rupture.Conclusions:Lp(a)has no significant correlation with classic blood lipid indicators such as LDL-C,HDL-C,TC,and TG,and is an independent risk factor for plaque rupture.The higher the level of Lp(a),the higher the risk of plaque rupture and acute myocardial infarction,which can play an early warning role and require sufficient clinical attention. |
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