高血压性心脏病患者Apelin、Elabela和脂蛋白相关磷脂酶A2水平变化及其临床意义  

Expression and clinical significance of Apelin,Elabela and lipoprotein associated phospholipase A2 in patients with hypertensive heart disease

作　　者：邵顺宏 徐军 张绍塘 Shao Shunhong;Xu Jun;Zhang Shaotang(Zhejiang University of Traditional Chinese Medicine,Hangzhou 310000,China;Department of Internal Medicine,the Fuyang District Second People′s Hospital of Hangzhou City,Hangzhou 311400,China)

机构地区：[1]浙江中医药大学,杭州310000 [2]杭州市富阳区第二人民医院内科,杭州311400

出　　处：《中国医师进修杂志》2022年第12期1121-1126,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨Apelin、Elabela(ELA)、脂蛋白相关磷脂酶A2(Lp-PLA2)在高血压性心脏病(HHD)患者中的表达及临床意义。方法选取2019年6月至2021年6月杭州市富阳区第二人民医院收治的HHD患者108例(观察组)和同期收治的未合并HHD的原发性高血压(EH)患者108例(对照组)为研究对象,比较两组临床指标及Apelin、ELA、Lp-PLA2水平;采用受试者工作特征(ROC)曲线分析Apelin、ELA、Lp-PLA2预测HHD的效能;按Apelin、ELA、Lp-PLA2中位数分为高Apelin组与低Apelin组、高ELA组与低ELA组、高Lp-PLA2组与低Lp-PLA2组,以发生主要心血管不良事件(MACE)为终点事件,应用Kaplan-Meier法绘制生存曲线并用Log-rank检验组间差异。结果观察组EH病程长于对照组[(8.74±2.25)年比(4.72±1.85)年],收缩压(SBP)、舒张压(DBP)、N末端B型利钠肽(NT-proBNP)、ELA、Lp-PLA2高于对照组[(136.82±11.47)mmHg(1 mmHg=0.133 kPa)比(124.83±12.72)mmHg、(82.52±5.73)mmHg比(78.96±5.95)mmHg、(3624.35±1023.13)ng/L比(934.24±352.53)ng/L、(5.16±2.17)μg/L比(2.44±1.97)μg/L、(182.72±89.76)μg/L比(114.67±46.22)μg/L],Apelin、左室射血分数(LVEF)低于对照组[(28.75±13.29)ng/L比(56.82±19.84)ng/L、(52.16±6.72)%比(58.63±6.87)%],差异均有统计学意义(P<0.05)。Apelin与LVEF呈正相关(r=0.530,P<0.05),ELA、Lp-PLA2与LVEF呈负相关(r=-0.751、-0.785,P<0.05);Apelin与NT-proBNP呈负相关(r=-0.358,P<0.05),ELA、Lp-PLA2与NT-proBNP呈正相关(r=0.739、0.727,P<0.05)。ROC曲线分析显示,Apelin、ELA、Lp-PLA2预测HHD的曲线下面积分别为0.732、0.761、0.843。Logistic回归分析结果显示,EH病程(OR=1.325)、Apelin(OR=0.563)、ELA(OR=2.348)、Lp-PLA2(OR=2.573)是发生HHD的独立危险因素(P<0.05)。生存曲线分析结果显示,低Apelin组MACE发生率高于高Apelin组,高ELA组MACE发生率高于低ELA组,高Lp-PLA2组MACE发生率高于低Lp-PLA2组,差异均有统计学意义(P<0.01)。结论Apelin、ELA、Lp-PLA2可作为预测EH并发HHD的参考指标,且有助�Objective To investigate the expression and clinical significance of Apelin,Elabela(ELA),lipoprotein associated phospholipase A2(LP-PLA2)in patients with hypertensive heart disease(HHD).Methods One hundred and eight HHD patients treated in the Fuyang District Second People′s Hospital of Hangzhou City from June 2019 to June 2021 were collected as the observation group,and 108 essential hypertension(EH)patients without HHD during the same period were collected as the control group.The clinical indicators and the levels of Apelin,ELA and LP-PLA2 were compared between the two groups.Receiver operating characteristic(ROC)curve was used to analyze the efficacy of Apelin,ELA and LP-PLA2 in predicting HHD.According to the median of Apelin,ELA and LP-PLA2,the patients were divided into high Apelin group and low Apelin group,high ELA group and low ELA group,high LP-PLA2 group and low LP-PLA2 group,with adverse cardiovascular events(MACE)as the end point.Kaplan-Meier method was used to plot the survival curve and Log-rank was used to test the difference between groups.Results The course of EH in the observation group was longer than that in the control group:(8.74±2.25)years vs.(4.72±1.85)years;systolic pressure,diastolic pressure,N-terminal B-type natriuretic peptide(NT-proBNP),Apelin,ELA,LP-PLA2 were higher than those in the control group:(136.82±11.47)mmHg(1 mmHg=0.133 kPa)vs.(124.83±12.72)mmHg,(82.52±5.73)mmHg vs.(78.96±5.95)mmHg,(3624.35±1023.13)ng/L vs.(934.24±352.53)ng/L,(5.16±2.17)μg/L vs.(2.44±1.97)μg/L,(182.72±89.76)μg/L vs.(114.67±46.22)μg/L;Apelin and left ventricular ejection fraction were lower than those in the control group:(28.75±13.29)ng/L vs.(56.82±19.84)ng/L,(52.16±6.72)%vs.(58.63±6.87)%,there were statistical differences(P<0.05).Apelin was positively correlated with LVEF(r=0.530,P<0.05),while ELA and LP-PLA2 were negatively correlated with LVEF(r=-0.751,-0.785,P<0.05).Apelin was negatively correlated with NT-proBNP(r=-0.358,P<0.05),ELA,LP-PLA2 were positively correlated with NT-pro

关 键 词：原发性高血压 高血压性心脏病 危险因素 预后 

分 类 号：R541.3[医药卫生—心血管疾病]