脂蛋白相关磷脂酶A2水平和动态动脉僵硬指数对原发性高血压患者左心功能的预测价值  

Predictive Value of Lp-PLA2 Concentration and AASI Level for Left Ventricular Function in Patients with Essential Hypertension

作　　者：信彩凤 张强[1] 杨丽红[2] 孙彩红[1] 姚芳 刘方方 费思杰 XIN Caifeng;ZHANG Qiang;YANG Lihong;SUN Caihong;YAO Fang;LIU Fangfang;FEI Sijie(Cardiovascular Department,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China;Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学第二附属医院心血管内科,河南省郑州市450014 [2]河南省人民医院,河南省郑州市450003

出　　处：《中国全科医学》2021年第29期3684-3691,共8页Chinese General Practice

基　　金：河南省科技攻关项目(182102310509)。

摘　　要：背景原发性高血压(EH)被认为是多种心脑血管疾病的独立危险因素,EH患者中动脉僵硬度增加与心脑血管发病率和死亡率有关,但目前临床缺乏更多的指标来帮助评估EH患者心功能的情况。目的探讨EH患者脂蛋白相关磷脂酶A2(Lp-PLA2)水平和动态动脉僵硬指数(AASI)对左心功能的预测价值。方法选取2020年在郑州大学第二附属医院心血管内科住院的216例患者为研究对象,按是否患有EH分为高血压组(观察组,122例)和无高血压组(对照组,94例)。收集患者性别、年龄、体质量、体质指数(BMI)、吸烟史、饮酒史、糖尿病史、血脂异常史等基线资料,测定尿酸(UA)、肌酐(Cr)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)等生化指标。检测Lp-PLA2水平和AASI,并与左心室射血分数(LVEF)及N末端B型尿钠肽前体(NT-proBNP)作相关性分析。根据LVEF水平及中位NT-proBNP水平,将两组患者分为LVEF≥50%亚组和LVEF<50%亚组,以及NT-proBNP≥514 ng/L亚组和NT-proBNP<514 ng/L亚组,比较LVEF亚组间及NT-proBNP亚组间Lp-PLA2水平和AASI的差异;采用多因素Logistic回归分析探讨LVEF、NT-proBNP及EH的影响因素,采用受试者工作特征曲线(ROC曲线)分析Lp-PLA2、AASI对心力衰竭的诊断价值。结果两组年龄、UA、Lp-PLA2、AASI、SBP、NT-ProBNP、LVEF比较,差异有统计学意义(P<0.05)。线性回归分析显示,观察组Lp-PLA2水平、AASI与LVEF水平呈负相关(r=-0.437、-0.580,P=0.036、0.001);Lp-PLA2水平、AASI与NT-ProBNP水平呈正相关(r=0.309、0.519,P=0.038、0.041)。对照组Lp-PLA2水平、AASI与LVEF无线性相关关系(r=0.027、0.019,P=0.601、0.372),与NT-ProBNP也无线性相关关系(r=0.033、0.058,P=0.460、0.703)。多因素Logistic回归分析结果显示,EH史、Lp-PLA2、AASI是LVEF的影响因素(P<0.05),Lp-PLA2、AASI是NT-ProBNP的影响因素(P<0.05),吸烟Background Essential hypertension is supposed to be independently associated with increased risk of multiple cardio-cerebrovascular diseases,and increased arterial stiffness in essential hypertension is associated with increased cardiovascular morbidity and mortality.However,there is a lack of adequate indicators to evaluate the cardiac function of essential hypertension patients.Objective To investigate the predictive value of lipoprotein-associated phospholipase A2(Lp-PLA2)concentration and ambulatory arterial stiffness index(AASI)on left ventricular function in patients with essential hypertension.Methods A total of 216 inpatients(including 122 with essential hypertension and 94 without)were selected from Cardiovascular Department the Second Affiliated Hospital of Zhengzhou University in 2020.Data were collected,including general information(gender,age,body weight,BMI,history of smoking,drinking,diabetes,and dyslipidemia),and biomarkers〔serum uric acid(SUA),creatinine,fasting plasma glucose,glycosylated hemoglobin,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,C-reactive protein,NT-proBNP,Lp-PLA2,AASI,and left ventricular ejection fraction(LVEF)〕.The concentrations of Lp-PLA2 and AASI were compared between LVEF≥50%and<50%subgroups to explore the association of them with LVEF,and between NT-proBNP≥514 ng/L and<514 ng/L subgroups(stratified by the median value NT-proBNP)to explore the association of them with NT-proBNP.Multivariate Logistic regression was used to explore risk factors of LVEF,NT-proBNP and hypertension.ROC analysis was conducted to assess the predictive value of Lp-PLA2 and AASI for heart failure.Results Patients with and without essential hypertension showed significant differences in mean age,and SUA,Lp-PLA2,AASI,SBP,NT-proBNP and LVEF(P<0.05).Linear regression analysis indicated that LVEF was negatively correlated with Lp-PLA2(r=-0.437,P=0.036),and AASI(r=-0.580,P=0.001),but NT-ProBNP was positively correlated with Lp-PLA2(r=0.309,P=0.038)and AASI

关 键 词：原发性高血压 动态血压监测 1-烷基-2-乙酰甘油磷酸胆碱酯酶 动态动脉硬化指数 左心功能 预测价值 

分 类 号：R544.1[医药卫生—心血管疾病]