载脂蛋白A1预测老年缺血性心肌病心衰患者预后的价值  

Prognostic value of apolipoprotein A1 in elderly patients with ischemic cardiomyopathy and heart failure

作　　者：仲崇霞 刘益海 房其军[2] 沙杜娟 康丽娜[1] 徐标[1] 倪杰[4] ZHONG Chong-xia;LIU Yi-hai;FANG Qi-jun;SHA Du-juan;KANG Li-na;XU Biao;NI Jie(Department of Cardiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing,Jiangsu 210008,China;不详)

机构地区：[1]南京大学医学院附属鼓楼医院心血管内科,江苏南京210008 [2]南京大学医学院附属鼓楼医院中医科 [3]南京大学医学院附属鼓楼医院全科医学科 [4]南京大学医学院附属鼓楼医院急诊医学科

出　　处：《中华全科医学》2022年第4期546-549,601,共5页Chinese Journal of General Practice

基　　金：国家自然科学基金青年科学基金项目(82100398)。

摘　　要：目的观察老年缺血性心肌病心衰患者血清载脂蛋白A1(apoA1)水平,探究血清apoA1对老年缺血性心肌病心衰患者预后的价值。方法选取2018年3月—2019年12月符合入组标准的在南京鼓楼医院心血管内科住院的老年缺血性心肌病心衰患者,电话随访终点事件。根据是否发生心源性死亡将患者分为2组,比较不同亚组住院期间的基线资料(年龄、性别、BMI等)、血清学指标(BNP、apoA1、HDL-C等)和影像学指标(超声心动图)。结果共纳入105例患者,其中9例(8.7%)在随访期间发生心源性死亡。比较2组数据的年龄、性别、血压、心率、BMI、吸烟饮酒史、合并症、用药等方面,发现纽约心功能等级高、合并地高辛用药史患者病死率升高(P<0.05),余差异均无统计学意义。使用单因素分析初步筛查可能的影响预后的因素,发现在发生心源性死亡组中,BNP、球蛋白升高,HDL-C及apoA1降低(P<0.05);多因素logistic分析提示apoA1是发生心源性死亡的独立危险因素(OR<0.001,P=0.007)。将患者按照apoA1水平分为低值组和高值组,发现低值组具有更高的CRP水平(t=3.505,P<0.01);将球蛋白、HDL-C、apoA1、BNP联合绘制ROC曲线,ROC曲线下面积为0.863,提示模型预测效果较好。结论ApoA1为老年缺血性心肌病心衰患者发生心源性死亡的独立危险因素,能较好地预测预后。Objective To observe the level of serum apolipoprotein A1(apoA1)in elderly patients with ischemic cardiomyopathy and heart failure,and to explore the prognostic value of serum apoA1 in elderly patients with ischemic cardiomyopathy and heart failure.Methods Elderly patients with ischemic cardiomyopathy and heart failure hospitalized in the Cardiology Department of Nanjing Drum Tower Hospital from March 2018 to December 2019 were selected retrospectively.The end events were followed up by telephone.The patients were divided into two groups according to whether cardiac death occurred or not.The baseline data(age,gender,BMI,etc.),serological indexes(BNP,apoA1,HDL-C,etc.)and imaging indexes(echocardiography)of different subgroups were compared.Results A total of 105 patients were included,of which 9 cases(8.7%)had cardiac death during follow-up.The age,gender,blood pressure,heart rate,BMI,smoking and drinking history,complications and medication history were compared between the two groups.It was found that the mortality rate of patients with higher the New York Heart Association(NYHA)grade and digoxin medication history increased(P<0.05),but there was no significant difference in the rest between the two groups.Univariate analysis showed that the increase of BNP and globulin and the decrease of HDL-C and apoA1 were possible prognostic factors in the group of cardiac death(P<0.05).Multivariate logistic regression analysis showed that apoA1 was an independent risk factor for cardiac death(OR<0.001,P=0.007).The patients were divided into low value group and high value group according to the level of apoA1.It was found that the low value group had a higher level of C-reactive protein(t=3.505,P<0.01).The ROC curve of globulin,HDL cholesterol,apoA1,BNP was drawn together,and area under ROC curve was 0.863,indicating the preferable prediction effect of the model.Conclusion ApoA1 is an independent risk factor for cardiac death in elderly patients with ischemic cardiomyopathy and heart failure.

关 键 词：载脂蛋白A1 缺血性心肌病 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病] R542.21[医药卫生—内科学]