| Objectives To explore the potential relationship between the characteristics of coronary atherosclerotic plaques and serum Lp(a)levels by observing and analyzing the coronary CTA images of patients in this study.Methods From October 2017 to August 2019,188 patients with suspected coronary heart disease and elevated serum Lp(a)were selected as the observation group;in addition,188patients with suspected coronary heart disease and normal serum Lp(a)were randomly selected as the control group.The basic clinical data such as gender,age,blood pressure,blood lipid,diabetes history,family history and body mass index of the two groups were reviewed and recorded.Record observation group of patients and the control group patients with coronary artery main branches(right coronary artery,left coronary artery,left anterior descending coronary artery,left coronary artery from the cyclotron)atherosclerotic plaque number,number of main branch of coronary artery plaque with different properties(plaque components and load)and the pathological changes of vascular segments,etc.SPSS17.0statistical software was used to analyze the obtained data.The measurement data between the two groups were tested by t test,while the count data were tested byχ~2test(α=0.05,P<0.05).Results The incidence of atherosclerotic plaque was 76.6%in patients with elevated serum Lp(a)and 66.5%in patients with normal serum Lp(a).There was significant difference between the two groups(χ~2=4.72,P=0.03,P<0.05);The proportion of diseased vessels in patients with elevated serum Lp(a)and normal serum Lp(a)was 11.5%and 5.0%,respectively.There was significant difference between the two groups(χ~2=48.44,P=0.00,P<0.05);The incidences of calcified plaque,non calcified plaque and mixed plaque were 49.6%,26.6%and 23.8%in patients with elevated serum Lp(a),respectively.The incidences of calcified plaque,non calcified plaque and mixed plaque were 63.3%,20.1%and 16.6%in patients with normal serum Lp(a),respectively.There was significant difference between the two groups(χ~2=22.02,P=0.00,P<0.05);The early plaques accounted for 51.0%and the progressive plaques accounted for 49.0%in patients with elevated serum Lp(a),while the early plaques accounted for 68.5%and the progressive plaques accounted for 31.5%in patients with normal serum Lp(a);The results of the two groups were different in statistical analysis(χ~2=36.43,P=0.00,P<0.05);The incidence of right coronary artery calcified plaque,non calcified plaque and mixed plaque in patients with elevated serum Lp(a)was 50.0%,27.9%and 22.1%,respectively.The incidence of right coronary artery calcified plaque,non calcified plaque and mixed plaque in patients with normal serum Lp(a)was 64.8%,22.1%and 13.1%,respectively.There was significant difference between the two groups(χ~2=8.44,P=0.01,P<0.05);The proportion of early plaque and advanced plaque in patients with elevated serum Lp(a)was54.1%and 45.9%respectively.The proportion of early plaque and advanced plaque in patients with normal serum Lp(a)was 76.6%and 23.4%respectively.There was significant difference between the two groups(χ~2=19.03,P=0.00,P<0.05);The incidences of calcified plaque,non calcified plaque and mixed plaque in the left main artery of patients with elevated serum Lp(a)were 75.8%,6.1%and 18.1%,respectively.The incidences of calcified plaque,non calcified plaque and mixed plaque in the left main artery of patients with normal serum Lp(a)were 78.6%,16.7%and 4.7%,respectively;There was no statistical difference between the two groups(P~*=0.09,P>0.05);The early left main artery plaques accounted for 69.7%and advanced plaques accounted for 30.3%in patients with elevated serum Lp(a),while the early left main artery plaques accounted for 73.8%and advanced plaques accounted for 26.2%in patients with normal serum Lp(a).There was no statistical difference between the two groups(χ~2=0.16,P=0.69,P>0.05).Patients with elevated serum Lp(a)set of left anterior descending branch calcified plaque,non calcified plaque,mixed plaque incidence was 44.2%,29.1%,26.7%,serum Lp(a)group of patients with normal left anterior descending branch calcified plaque,non calcified plaque,mixed plaque incidence was 57.1%,18.3%,24.6%,two groups of results there are differences in statistical analysis(χ~2=10.17,P=0.006,P<0.05);Early and advanced plaques accounted for 46.0%and 54.0%in the left anterior descending branch in the elevated serum Lp(a)group,while early plaques accounted for 63.5%and advanced plaques accounted for 36.5%in the normal serum Lp(a)group.There were significant differences between the two groups in statistical analysis(χ~2=14.96,P=0.00,P<0.05).The incidence of calcified plaque,non-calcified plaque and mixed plaque in the left cyclotronic branch of serum Lp(a)group was 54.5%,24.1%and 21.4%,respectively.The incidence of calcified plaque,non-calcified plaque and mixed plaque in the normal group was 67.9%,22.3%and 9.8%,respectively.The difference between the two groups was statistically significant(χ~2=6.55,P=0.00,P<0.05).The early plaques of left circumflex artery accounted for 51.8%and the progressive plaques accounted for 48.2%in the patients with elevated serum Lp(a),while the early plaques and the progressive plaques accounted for 66.0%and 34.05%in the patients with normal serum Lp(a).There were differences between the two groups in statistical analysis(χ~2=4.72,P=0.029,P<0.05).The proportion of atherosclerotic plaques in different components of right coronary artery,left anterior descending artery and left circumflex artery in patients with elevated serum Lp(a)was not statistically significant(χ~2=4.14,P=0.39,P>0.05);The proportion of early plaque and advanced plaque in these three coronary arteries was not statistically significant(χ~2=3.34,P=0.19,P>0.05).Conclusions 1 Compared with patients with normal serum Lp(a),patients with elevated serum Lp(a)were more likely to develop atherosclerotic plaque,coronary artery disease,unstable plaque and progressive plaque.2 Compared with patients with normal serum Lp(a)concentration,patients with elevated serum Lp(a)had an increased likelihood of developing unstable plaques(non-calcified plaques and mixed plaques)in the right coronary artery,left anterior descending artery and left circular artery,and atherosclerotic plaques were more likely to develop into progressive plaques.3 The effect of serum Lp(a)concentration on the specific properties of the left main plaque is not clear at the current research level.4 It can not be considered that Lp(a)has different effects on the occurrence and development of atherosclerotic plaques(plaque composition and plaque load)in patients with right coronary artery,left anterior descending artery and left circumflex artery.Figure 4;Table 15;Reference 104... |
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