家族性高コレステロール血症と高Lp（a）血症の冠動脈硬化症に及ぼす影響について—冠動脈造影所見の比較検討

Coronary Angiograms in Comparison with Farnilial Hypercholesterolemia and Hyper-Lp (a) mia

　家族性高コレステロール血症（FH）と高Lp（a）血症が冠動脈硬化症に及ぼす影響を対比した．未治療症例で今回初めてFHと診断され，かつ血清Lipoprotein（a）｛Lp（a）｝値50mg／dl以上の高Lp（a）血症（FH・LP（a）群）5例（男3例，女2例），FH単独（FH群）18例（男15例，女3例），血清Lp（a）値50mg／dl以上単独（Lp（a）群）14例（男7例，女7例）を対象とした．亜硝酸剤投与下で右3方向，左6方向の冠動脈造影検査を行い，AHAの診断基準にて狭窄度を判定し，その所見からcoronary stenosis index（CSI）を算出した．

　CSIに対する5項目の偏相関係数は，年齢；O．306，性；−0.186（男性を1，女性を2として），HDL-C；0.007,LDL-C；0.416,Lp（a）；0.022であり，LDL-Cのみが有意（p＜0.05）にCSIに寄与していた．家族性高コレステロール血症と高Lp（a）血症の冠動脈造影所見を比較検討すると，冠動脈狭窄はLDL-Cと最も深く関係しLp（a）とは希薄であった．

The subjects were 23 consecutive patients (18 men and 5 women) with heterozygous FH who were referred to our hospital for coronary angiographic evaluation, and 15 consecutive patients (15 men and 3 women) with hyper-Lp (a) mia (≧50mg/dl). Laboratory data was checked before treatment. Coronary angiography was performed by the Judkins technique before and after sublingual administration of 0.3 mg of nitroglycerin or coronary infusion of 2.5mg of isosorbide dinitrate. Patients were divided into 3 groups; those with FH and LP (a) (FH-LP (a) group), FH group and LP (a) group.

The stepwise discriminant analysis demonstrated that LDL-Ccould be an independent risk factor for coronary stenosis, but age, gender, HDL-C and Lp (a) did not influence the coronary stenosis index.

These data suggest that, compared to hyper-Lp (a) mia, increased levels of LDL-C can been thought to be the chief cause of coronary atherosclerosis.