관동맥 질환의 위험인자로서 Lipoprotein(a)의 임상적 의의

Abstract

[한글]

1960년대 초 Berg에 의해 처음 발견된 Lipoprotein(a)[Lp(a)]는 1970년대 이후 허혈성 심질환 및 뇌혈관 질환의 위험요소로 알려져 있다. 그후 인체에서 Lp(a)의 농도분포 및 작용기전에 대한 연구가 활발히 진행되고 있으며, Lp(a)의 농도가 20-40 mg/dl이상시 관

동맥 죽상경화와 높은 연관관계가 있는 것으로 알려져 있다. 우리나라에서도 정상인과 당뇨병에서의 Lp(a)의 분포에 관한 연구가 있으며, 소수의 Lp(a)와 관동맥 질환과 관련된 연구가 있을 뿐이다.

이에 본 연구에서는 관동맥 질환의 위험인자로서의 Lp(a)의 임상적 유용성을 알아보고자 하였다.

혈청 Lp(a)는 허혈성 심질환이 의심되어 내원하여 관동맥 조영술을 시행한 88예의 환자에서 방사면역법(Radioimmunoassay)을 이용하여 측정하였다. 모든 환자에서 관동맥 조영술을 시행하였고 이들을 대조군 36예, 관동맥 질환군 52예로 나누었는데 이중 30예는 단

일혈관 질환이었고 22예는 다혈관 질환이었다. Lp(a)외에 총 콜레스테롤, 트리글리세라이드, 고밀도 지단백 콜레스테롤, 저밀도 지단백 콜레스테롤을 측정하였다.

본 연구의 결과 대조군에서는 혈청 Lp(a)치가 10 ㎎/dl이하가 41 %이상을 차지하는 낮은 농도가 많은 비대칭 분포를 보였으며, 관동맥 질환군에서는 혈청 Lp(a)치가 30 mg/dl이상이 48.1 %로 높은 빈도를 보였다. 다른 관동맥의 위험인자로 알려진 혈청 지질, 당뇨병, 고혈압등은 혈청 Lp(a)와 통계학적 연관성이 없었다. 대조군과 관동맥 질환군의 성별, 연령별 차이는 없었고, 혈청 지질등 알려진 위험인자도 두군간에 차이가 없었으나(P>0.05), 혈청 평균 Lp(a)치는 관동맥 질환군에서 32.7±31.8 ㎎/dl로 정상 대조군의 20.4±15.8 ㎎/dl보다 높아 통계학적으로 유의하게 높았다(P<0.01). 한편 Lp(a)치가 관동맥 질환의 독립적 위험인자로 존재한다면 관동맥 질환이 심한 경우 Lp(a)치가 증가할 것으로 예측 할 수 있겠다. 본 연구에서는 관동맥 질환의 정도에 따른 혈청 LP(a)치는 다혈관 질환

군에서 40.3±34.5 ㎎/dl로 단일혈관 질환군의 26.3±15.3 ㎎/dl에 비하여 통계적으로 유의하게 높았다(P<0.05),

결론적으로 본 연구에서는 관동맥 질환의 위험인자로서의 Lp(a)가 임상적으로 관동맥 질환을 진단하는데 매우 유용하며 특히 Lp(a)치가 높은 경우에는 관동맥 질환중 정도가 심한 다혈관 질환을 감별하는데 유용할 것으로 생각되나 이에 대하여는 보다 많은 연구가 필요하리라 생각된다.

Clinical Significance of Lipoprotein(a) as a Risk Factor for Coronary Artery

Disease

Dong Seong Choi

Department of Medical Science The Graduate School, Yonsei University

(Directed by Professor Young Hak Shim)

Lipoprotein (a)[Lp(a)] is a low density lipoprotein first identified by

Berg(1963). There is growing evidence that the Lp(a) is a good biochemical marker

for both cardiovascular and cerebrovascular disease.

The purpose of this study was to examine the Lp(a) levels in a group of patients

with coronary artery disease compared with a control group and to assess the

correlation between Lp(a) levels and other risk factors for coronary artery

disease.

In this study, Lp(a) serum levels were determined by radioimmunoassay in 88

patients with suspected ischemic heart disease. Of these, 36 had no obstruction in

the coronary arteries(Cath control group), while in the remainder, the presence of

coronary artery stenosis was determined in more than 50 %(CAD group) by coronary

angiography : 30 with single and 22 with multiple vessel disease. In addition to

Lp(a), serum total cholesterol, triglyceride, HDL cholesterol , and LDL cholesterol

were measured.

The distribution of Lp(a) levels in the control subjects was highly skewed with a

mean Lp(a) level of 20.4 ± 15.8 ㎎/dl. In coronary artery disease subjects the

Lp(a) levels shifted to higher with 48.1 ± of the subjects above the 30 ㎎/dl

level. A significant difference was found in Lp(a) levels among patients with

coronary artery disease(32.9 ± 31.74 ㎎/dl) and normal coronary artery status(20.4

± 15.8 ㎎/dl), Lp(a) levels were not correlated with cholesterol, LDL cholesterol,

triglyceride, or HDL cholesterol in patient and control subjects. The patients with

significant coronary artery disease of two or more vessels(40.3 ± 34.5 ㎎/dl) were

found to have higher Lp(a) levels than those with single vessel disease(26.3 ±

15.3 ㎎/dl ).

In conclusion, It is suggested that serum Lp(a) is an independent risk factor for

coronary artery disease, and is clinically useful for diagnosing coronary artery

disease. The above data indicate that, in subject with coronary artery disease,

determining Lp(a) level will assist in differentiating between single and multiple

vessel involvement. However, further study is required.

[영문]

Lipoprotein (a)[Lp(a)] is a low density lipoprotein first identified by Berg(1963). There is growing evidence that the Lp(a) is a good biochemical marker for both cardiovascular and cerebrovascular disease.

The purpose of this study was to examine the Lp(a) levels in a group of patients with coronary artery disease compared with a control group and to assess the correlation between Lp(a) levels and other risk factors for coronary artery disease.

In this study, Lp(a) serum levels were determined by radioimmunoassay in 88 patients with suspected ischemic heart disease. Of these, 36 had no obstruction in the coronary arteries(Cath control group), while in the remainder, the presence of coronary artery stenosis was determined in more than 50 %(CAD group) by coronary angiography : 30 with single and 22 with multiple vessel disease. In addition to Lp(a), serum total cholesterol, triglyceride, HDL cholesterol , and LDL cholesterol

were measured.

The distribution of Lp(a) levels in the control subjects was highly skewed with a mean Lp(a) level of 20.4 ± 15.8 ㎎/dl. In coronary artery disease subjects the Lp(a) levels shifted to higher with 48.1 ± of the subjects above the 30 ㎎/dl

level. A significant difference was found in Lp(a) levels among patients with coronary artery disease(32.9 ± 31.74 ㎎/dl) and normal coronary artery status(20.4 ± 15.8 ㎎/dl), Lp(a) levels were not correlated with cholesterol, LDL cholesterol, triglyceride, or HDL cholesterol in patient and control subjects. The patients with significant coronary artery disease of two or more vessels(40.3 ± 34.5 ㎎/dl) were found to have higher Lp(a) levels than those with single vessel disease(26.3 ± 15.3 ㎎/dl ).

In conclusion, It is suggested that serum Lp(a) is an independent risk factor for coronary artery disease, and is clinically useful for diagnosing coronary artery disease. The above data indicate that, in subject with coronary artery disease, determining Lp(a) level will assist in differentiating between single and multiple vessel involvement. However, further study is required.