Lp-PLA2联合Gensini积分对老年NSTE-ACS患者近期MACE的预测价值  

Predictive value of Lp-PLA2 combined with Gensini score for recent MACE in elderly patients with NSTE-ACS

作　　者：王永刚 徐宁 刘宇鸿 宋昱 WANG Yonggang;XU Ning;LIU Yuhong;SONG Yu(Clinical College of Cardiovascular Disease,Tianjin Medical University,Department of Emergency,TEDA International Cardiovascular Hospital,Tianjin 300457,China;Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine,Tianjin 300457,China)

机构地区：[1]天津医科大学心血管病临床学院,泰达国际心血管病医院急诊科,天津300457 [2]天津市心血管病分子调控及转化医学重点实验室,天津300457

出　　处：《天津医科大学学报》2025年第2期139-143,共5页Journal of Tianjin Medical University

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-020A)。

摘　　要：目的:探讨脂蛋白相关磷脂酶A2(Lp-PLA2)与冠状动脉狭窄严重程度积分(Gensini积分)对65岁以上老年急性非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者近期发生心血管不良事件(MACE)的预测价值。方法:回顾性分析2020年1月到2021年7月泰达国际心血管病医院急诊科222例老年NSTE-ACS患者的病例资料。所有患者以随访期间是否发生MACE,分为MACE组和非MACE组,比较二者之间Lp-PLA2、Gensini积分差异,分析Lp-PLA2与Gensini积分对MACE的预测价值;根据冠状动脉造影结果计算Gensini积分,分为:轻度、中度、重度3组,对各组MACE发生率、Lp-PLA2水平进行比较;采用Pearson相关分析Lp-PLA2与Gensini积分的相关性。多因素Logistic回归分析MACE发生的危险因素;结果:MACE组Lp-PLA2、Gensini积分、总胆固醇(TC)、低密度脂蛋白-胆固醇(LDL-C)显著高于非MACE组,血浆脑钠肽(BNP)、收缩压显著低于非MACE组,差异具有统计学意义(t=-6.243、-6.546、-3.148、-3.228、-6.321、2.636,均P<0.01);Gensini积分与血清Lp-PLA2预测MACE曲线下面积分别为0.864(95%CI:0.770~0.912,P<0.01)、0.817(95%CI:0.738~0.897,P<0.01);两项指标联合预测MACE曲线下面积为0.892(95%CI:0.770~0.912,P<0.01)。冠状动脉狭窄程度中度组MACE发生率显著高于轻度组,重度组MACE发生率显著高于中度组,差异具有统计学意义(χ^(2)=34.068,P<0.01);重度组LP-LPA2水平显著高于中度组和轻度组,中度组Lp-LPA2水平显著高于轻度组,差异具有统计学意义(均F=22.739,P<0.01)。Pearson相关分析显示血清Lp-PLA2与Gensini积分呈正相关(r=0.403,P<0.01)。多因素Logistic回归分析显示:Lp-PLA2(OR=1.017,95CI:1.007~1.026,P=0.001)与Gensini积分(OR=1.020,95CI:1.009~1.031,P=0.000)为MACE发生的独立危险因素。结论:老年NSTE-ACS患者血清Lp-PLA2水平与冠状动脉狭窄严重程度呈正相关,二者联合可以有效预测老年NSTE-ACS患者近期MACE发生风险。Objective:To explore the predictive value of lipoprotein-associated phospholipase A2(Lp-PLA2)and coronary stenosis severity score(Gensini score)for recent major adverse cardiovascular events(MACE)in elderly patients over 65 years old with acute non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods:A total of 222 elderly patients with NSTE-ACS selected in the Department of Emergency,TEDA International Cardiovascular Hospital from January 2020 to July 2021 were analyzed retrospectively.All patients were divided into MACE group and non-MACE group according to whether MACE occurred during the follow-up.The difference of Lp-PLA2 and Gensini scores between them was compared,and the predictive value of Lp-PLA2 and Gensini scores for MACE was analyzed.According to the results of coronary angiography,the Gensini score was calculated and divided into three groups:mild,moderate and severe,and the incidence of MACE and the level of Lp-PLA2 in each group were compared.Pearson correlation analysis was used to analyze the correlation between Lp-PLA2 and Gensini score.Multivariate Logistic regression was used to analyze the risk factors of MACE.Results:Lp-PLA2,Gensini score,total cholesterol(TC)and low density lipoprotein cholesterol(LDL-C)in MACE group were significantly higher than those in non-MACE group,while plasma brain natriuretic peptide(BNP)and systolic blood pressure were significantly lower than those in non-MACE group,with statistical significance(t=-6.243,-6.546,-3.148,-3.228,-6.321,2.636,all P<0.01).The area under MACE curve predicted by Gensini score and serum Lp-PLA2 was 0.864(95%CI:0.770-0.912,P<0.01),0.817(95%CI:0.738-0.897,P<0.01).The area under MACE curve predicted by the two indexes was 0.892(95%CI:0.770-0.912,P<0.01).Compared with different groups of coronary artery stenosis,the incidence of MACE in moderate group was significantly higher than that in mild group,and the incidence of MACE in severe group was significantly higher than that in moderate group,with statistical significance(χ^(2)=34

关 键 词：脂蛋白磷脂酶A2 急性冠状动脉综合征 冠状动脉病变严重程度 心血管不良事件 

分 类 号：R541.4[医药卫生—心血管疾病]