脂蛋白(a)升高可预测急性冠脉综合征后糖尿病患者复发性心肌梗死。
完整摘要 · 中文译文
背景：经历急性冠脉综合征（ACS）的2型糖尿病（T2DM）患者尽管接受了二级预防，仍处于复发性缺血事件的高风险中。脂蛋白(a)[Lp(a)]参与残余心血管风险，但其对糖尿病患者在ACS或经皮冠状动脉介入治疗（PCI）后复发心肌梗死（MI）和再次血运重建的预后影响尚不明确。 假设：我们假设Lp(a)升高与糖尿病患者在ACS或PCI后复发MI和再次冠状动脉血运重建风险增加相关。 方法：我们进行了一项遵循PRISMA指南的系统综述和荟萃分析。检索了PubMed、EBSCOhost和Cochrane Library中评估糖尿病患者在ACS或PCI后Lp(a)与复发性心血管结局的研究。纳入报告风险比（HR）及95%置信区间（CI）的观察性研究。采用随机效应模型计算合并HR。 结果：共纳入7项研究，包含7887例既往经历ACS或PCI的糖尿病患者。Lp(a)升高与复发MI风险增加相关（合并HR 2.17，95% CI 1.02-4.62；I2 = 75%），但与再次冠状动脉血运重建无关（合并HR 1.68，95% CI 0.79-3.57；I2 = 78%）。 结论：Lp(a)升高与糖尿病患者在ACS或PCI后复发MI风险增加相关。解读研究结果时应考虑观察性研究设计、显著异质性以及再次血运重建证据有限等因素。这些研 研究结果支持脂蛋白(a)（Lp(a)）是残余心血管风险的促成因素，并支持其在对急性冠脉综合征（ACS）后风险分层中的潜在作用。 试验注册：本研究已在前瞻性注册的国际系统评价注册平台（PROSPERO；注册号 CRD420261296821）中完成前瞻性注册。
完整摘要 · 英文原文
BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) who experience acute coronary syndromes (ACS) remain at high risk for recurrent ischemic events despite secondary prevention. Lipoprotein(a) [Lp(a)] contributes to residual cardiovascular risk, but its prognostic impact on recurrent myocardial infarction (MI) and repeat revascularization in diabetic patients after ACS or percutaneous coronary intervention (PCI) remains unclear. HYPOTHESIS: We hypothesized that elevated Lp(a) is associated with increased risk of recurrent MI and repeat coronary revascularization in patients with diabetes after ACS or PCI. METHODS: We conducted a PRISMA-guided systematic review and meta-analysis. PubMed, EBSCOhost, and Cochrane Library were searched for studies evaluating Lp(a) and recurrent cardiovascular outcomes in patients with diabetes after ACS or PCI. Observational studies reporting hazard ratios (HRs) with 95% confidence intervals (CIs) were included. Pooled HRs were calculated using random-effects models. RESULTS: Seven studies comprising 7887 patients with diabetes and prior ACS or PCI were included. Elevated Lp(a) was associated with increased risk of recurrent MI (pooled HR 2.17, 95% CI 1.02-4.62; I2 = 75%) but not repeat coronary revascularization (pooled HR 1.68, 95% CI 0.79-3.57; I2 = 78%). CONCLUSIONS: Elevated Lp(a) was associated with increased risk of recurrent MI in patients with diabetes after ACS or PCI. Findings should be interpreted considering the observational study designs, substantial heterogeneity, and limited evidence for repeat revascularization. These findings support Lp(a) as a contributor to residual cardiovascular risk and its potential role in post-ACS risk stratification. TRIAL REGISTRATION: This study was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420261296821).