术前血清脂蛋白a和低密度脂蛋白胆固醇预测急性冠状动脉综合征患者PCI术后短期不良预后价值的比较  

Comparison of the value of preoperative serum LP(a)and LDL-C levels in predicting short-term adverse prognosis in patients with acute coronary syndrome after PCI

作　　者：郝岩 潘洋 高洪瑞 郭永芳[1] 葛均华[1] 李健[1] HAO Yan;PAN Yang;GAO Hongrui;GUO Yongfang;GE Junhua;LI Jian(Department of Cardiology,the Affiliated Hospital of Qingdao University,Qingdao,Shandong,266000,China)

机构地区：[1]青岛大学附属医院心内科,山东青岛266000

出　　处：《临床心血管病杂志》2020年第12期1115-1119,共5页Journal of Clinical Cardiology

基　　金：山东省自然科学基金(No:ZR2017MH056)。

摘　　要：目的:比较术前血清脂蛋白a[LP(a)]和低密度脂蛋白胆固醇(LDL-C)对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后短期内不良预后的预测价值。方法:回顾性分析395例首次诊断ACS并且接受PCI术患者的临床资料。以全因死亡、心脏缺血导致的再次血运重建、不稳定型心绞痛导致的再入院以及非致死性脑卒中构成的复合事件为主要终点。根据6个月内是否发生主要终点事件,将患者分为无终点事件组(354例)和终点事件组(41例),比较组间差异。采用Logistic回归和亚组分析探究不良预后的相关危险因素,绘制受试者工作特征曲线(ROC)评估LP(a)和LDL-C对PCI术后ACS患者不良预后的诊断价值。结果:与无终点事件组相比较,终点事件组患者术前LP(a)水平更高(P<0.01),而LDL-C水平无统计学差异。单因素Logistic回归分析显示,LP(a)为ACS患者行PCI术后短期不良预后的独立危险因素(OR:1.002;95%CI:1.000~1.003;P<0.01),LP(a)≥300 mg/L患者出现结局事件的OR(95%CI)为3.621(1.792~3.718)(P<0.01)。ROC曲线分析显示,当LP(a)和LDL-C分别取截断值249 mg/L和2.64 mmol/L时,预测ACS患者PCI术后6个月终点事件的曲线下面积(AUC)分别为0.702(P<0.01)和0.524(P=0.621),诊断灵敏度分别为75.6%和43.9%,特异度分别为62.7%和68.2%。亚组分析显示,LP(a)≥300 mg/L、LDL-C<1.8 mmol/L的患者较LP(a)<300 mg/L、LDL-C<1.8 mmol/L的患者更易出现不良心血管事件(P<0.01)。结论:对行PCI术后的ACS患者,术前血清LP(a)对短期不良预后的预测价值要高于LDL-C。Objective:To compare the preoperative serum lipoprotein a[LP(a)]with low-density lipoprotein cholesterol(LDL-C)in predicting short-term adverse prognosis in patients with acute coronary syndrome(ACS)after the percutaneous coronary intervention(PCI).Method:The clinical data of 395 patients diagnosed with ACS for the first time and who underwent PCI were retrospectively analyzed.Main endpoints consisted of all-cause death,revascularization due to cardiac ischemia,rehospitalization due to unstable angina,and non-fatal stroke.All included patients were divided into non-endpoints group(n=354)and endpoints group(n=41)according to the occurrence of primary endpoints within 6 months,the data between the two groups were compared.Logistic regression analysis and subgroup analysis were used to explore related risk factors of adverse prognosis,and receiver operating characteristic curve(ROC)analysis was used to evaluate the diagnostic value of LP(a)and LDL-C for adverse prognosis in ACS patients after PCI.Result:Compared with the non-endpoints group,patients in the endpoints group had higher preoperative LP(a)levels(P<0.01),while there was no statistical difference in LDL-C levels.Univariate Logistic regression analysis showed that LP(a)was an independent risk factor for short-term adverse prognosis after PCI in ACS patients(OR:1.002;95%CI:1.000-1.003;P<0.01),while the OR(95%CI)of LP(a)≥300 mg/L was 3.621(1.792-3.718)(P<0.01).ROC analysis showed that when the cut-off values of LP(a)and LDL-C were 249 mg/L and 2.64 mmol/L,respectively,the area under the curve(AUC)of LP(a)and LDL-C in predicting 6-month endpoints after PCI in ACS patients were 0.702(P<0.01)and 0.524(P=0.621),the diagnostic sensitivity were 75.6%and 43.9%,the specificity were 62.7%and 68.2%,respectively.Subgroup analysis revealed that patients with LP(a)≥300 mg/L and LDL-C<1.8 mmol/L were more likely to have adverse cardiovascular events compared with patients with LP(a)<300 mg/L and LDL-C<1.8 mmol/L(P<0.01).Conclusion:For ACS patients undergoing PCI,the pr

关 键 词：急性冠脉综合征 脂蛋白A 低密度脂蛋白胆固醇 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]