脂蛋白α、载脂蛋白B/A-1与颈动脉Crouse积分联合检测对冠状动脉病变程度的预测价值  

Predictive Value of Combined Examination of Lipoprotein A,Apolipoprotein B/A-1 and Carotid Crouse Score in the Degree of Coronary Artery Disease

作　　者：潘兴邦 李凡 陈晨 郭靖涛[2] 王福华[2] 罗东雷[2] 刘永华 尹育华[2] 周江[2] PAN Xing-bang;LI Fan;CHEN Chen;GUO Jing-tao;WANG Fu-hua;LUO Dong-lei;LIU Yong-hua;YIN Yu-hua;ZHOU Jiang(The Graduate School,Chengde Medical University,Chengde 067000,China;Department of Cardiology,Chengde Central Hospital,Chengde 067000,Hebei,China)

机构地区：[1]承德医学院研究生院,承德市067000 [2]承德市中心医院心血管内科,承德市067000

出　　处：《中国分子心脏病学杂志》2021年第2期3856-3860,共5页Molecular Cardiology of China

基　　金：河北省研究生创新资助项目(CXZZSS2020133)。

摘　　要：目的探讨联合检测人血清脂蛋白A、载脂蛋白B/A-1(Apo B/Apo A-1)及颈动脉Crouse积分判断冠状动脉病变严重程度的可行性。方法采用病例对照研究方法,选择2020年7月至2021年1月于我院行冠状动脉造影检查的患者122例,依据冠状动脉SYNTAX积分分为高危组(30例)和低危组(92例),比较两组基本临床资料、脂蛋白A、Apo B/Apo A-1、颈动脉Crouse积分以及其他实验室检查指标情况。多元线性回归及多因素Logistic回归用于评价脂蛋白A、Apo B/Apo A-1、Crouse积分与SYNTAX积分的相关性。受试者工作(ROC)曲线用于评价联合检测对冠状动脉高危病变的预测价值。结果在高危组和低危组患者中,糖尿病情况、脂蛋白A、Apo A-1、Apo B、Apo B/Apo A-1、Crouse积分及冠心病类型间差异具有统计学意义(P<0.05)。多元线性回归提示糖尿病情况、脂蛋白A、Apo B/Apo A-1、Crouse积分与冠状动脉SYNTAX积分呈正相关(标准化系数β分别为0.215,0.167,0.166,0.405,P<0.05)。多因素Logistic回归结果显示脂蛋白A、Apo B/Apo A-1、Crouse积分是冠状动脉高危病变的独立预测因素[OR分别为1.021(1.002,1.041),8.857(1.037,75.671),1.106(1.039,1.178),P<0.05]。ROC曲线结果证实联合检测脂蛋白A、Apo B/A-1、Crouse积分对预测SYNTAX高危具有很好的价值,ROC曲线下面积为0.826(95%CI:0.744,0.908,P<0.05)。约登指数最大为0.56,最佳截断值为0.15,敏感度和特异性分别为90%和66%。验证组包括11例高危病变和19例低危病变,经比对,联合检测的敏感度和特异性分别为72.73%和73.68%。结论脂蛋白A、Apo B/Apo A-1与颈动脉Crouse积分与冠状动脉病变程度相关,联合检测上述指标或有益于对冠状动脉病变程度的评估。Objective To investigate the feasibility of the combined examination of human serum lipoprotein A[LP(a)],apolipoprotein B/A-1(Apo B/A-1)and carotid Crouse score for the severity of coronary artery disease.Methods This study was designed with a case-control study method.A total of 122 patients who took the coronary angiography in our hospital from July 2020 to December 2020 was involved.The patients was divided into 2 groups with the coronary SYNTAX score,30 in high-risk group and 92 in low-risk group.The basic clinical data,Lp(a)and Apo B/Apo A-1,carotid Crouse integral and other laboratory examination indexes of the two groups were compared.Multivariate linear regression and multivariate Logistic regression were used to evaluate the correlation between Lp(a),Apo B/Apo A-1,Crouse score and SYNTAX score.Receiver Operating Characteristic(ROC)was used to evaluate the predictive value of combination examination for high-risk coronary artery disease.Results There were significant differences in diabetes status,LP(a),APO A-1,APO B,APO B/A-1,Crouse score and coronary heart disease type between the high-risk group and the low-risk group(P<0.05).Multiple linear regression showed that diabetes,Lp(a),Apo B/A-1,Crouse score were positively correlated with SYNTAX score(normalized coefficientsβwere 0.215,0.167,0.166,0.405,P<0.05).Multivariate Logistic regression showed that Lp(a),Apo B/A-1 and Crouse score were independent predictors of coronary high-risk lesions[OR were 1.021(1.002,1.041),8.857(1.037,75.671),1.106(1.039,1.178),P<0.05].ROC results confirmed that combined examination of Lp(a),Apo B/a-1 and Crouse score had good value in predicting SYNTAX.The area under ROC curve was 0.826(95%CI:0.744,0.908,P<0.05).The maximum Youden index was 0.56,the optimal cutoff value was 0.15,and the sensitivity and specificity were 90%and 66%respectively.The validation group included 13 high-risk lesions and 23 low-risk lesions.By comparison,the sensitivity and specificity of the combined detection were 84.62%and 73.91%respectively.Concl

关 键 词：冠心病 脂蛋白Α 载脂蛋白B/A-1 颈动脉Crouse积分 SYNTAX积分 

分 类 号：R541.4[医药卫生—心血管疾病]