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脂蛋白(a)与冠状动脉病变严重程度的关系及对不良心血管事件的影响 |
陈瑶琳,王尹曼,方达伟,张蒙,姚康,钱菊英
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1.复旦大学附属中山医院厦门医院心内科, 厦门 361015;2.复旦大学附属中山医院心内科, 上海市心血管病研究所, 上海 200032;3.泉州市第一医院心内科, 泉州 362000
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摘要: |
目的: 探讨脂蛋白(a)与老年冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉狭窄程度的相关性及其对主要不良心血管事件(major adverse cardiovascular event,MACE)的预测价值。方法: 回顾性分析复旦大学附属中山医院心内科2014年1月至12月入院行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的693例老年冠心病患者病例资料。入院时检测Lp (a)水平,根据Gensini评分计算冠状动脉狭窄程度。随访患者Lp (a)水平及是否发生MACE。结果: 按照Lp (a)水平三分位分组,3组间Gensini评分差异有统计学意义(P<0.05)。校正了其他危险因素后,低密度脂蛋白胆固醇(LDL-C)、InLp (a)与冠状动脉狭窄程度独立相关(P<0.05)。平均随访4.6年,共有91例患者发生MACE,Lp (a)水平是MACE的独立影响因素(P<0.05)。按是否发生MACE分组,基线及随访过程中LDL-C水平差异无统计学意义,基线及随访过程中MACE组Lp (a)显著高于非MACE组(P<0.05)。Lp (a)水平预测MACE的ROC曲线下面积(AUC)为0.582(95% CI 0.511~0.652),以血清浓度151 mg/L为临界值,预测灵敏度为61.5%、特异度为54.9%。结论: Lp (a)是预测冠状动脉狭窄程度的独立危险因素,排除LDL-C因素,Lp (a)水平与MACE的发生相关。 |
关键词: 冠心病 脂蛋白a 冠状动脉狭窄程度 主要不良心血管事件 |
DOI:10.12025/j.issn.1008-6358.2021.20202220 |
分类号:R541.4 |
基金项目: |
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Relationship between lipoprotein (a) and the severity of coronary artery disease and its influence on major adverse cardiovascular events |
CHEN Yao-lin1, WANG Yin-man2,3, FANG Da-wei4, ZHANG Meng1, YAO Kang2,3, QIAN Ju-ying2,3
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1.Department of Cardiology, Xiamen Branch, Zhongshan Hospital, Fundan University, Xiamen 361015, Fujian, China;2.Department of Cardiology, Zhongshan Hospital, Fundan University;3.Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China;4.Department of Cardiology, Quanzhou First Hospital, Quanzhou 362000, Fujian, China
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Abstract: |
Objective: To explore the correlation between lipoprotein (a) or Lp(a) and severity of coronary artery stenosis and its predictive value of major adverse cardiovascular events (MACE) in elderly patients with coronary artery disease (CAD). Methods: A total of 693 elderly patients with CAD who were admitted to the Department of Cardiology, Zhongshan Hospital, Fudan University from January 2014 to December 2014 for percutaneous coronary intervention (PCI) were selected. The serum Lp (a) level was detected and the severity of coronary artery stenosis was calculated according to the Gensini score on patient admission. The serum Lp (a) level changes and MACE were followed up. Results: The patients were divided into three groups according to the Lp (a) levels. There was statistically significant difference (P<0.05) in Gensini score among the three groups. The levels of LDL-C and InLp (a) were independently correlated with the degree of coronary artery stenosis after adjusting for multiple risk factors (P<0.05). A total of 91 cases of MACE occurred during the follow-up, and Lp (a) level was an independent influencing factor of MACE (P<0.05). According to whether MACE occurred or not, patients were divided into the MACE group and non-MACE group. LDL-C level was similar in the two groups at baseline and during follow-up. Lp (a) in MACE group was significantly higher than that in non-MACE group during follow-up (P< 0.05). The area under curve (AUC) of Lp (a) level was 0.582 (95% CI 0.511-0.652). The predicted sensitivity was 61.5%, and the specificity was 54.9% with a cut-off value of 151 mg/L (15.10 mg/mL) of the serum Lp (a). Conclusions: Lp (a) may be an independent risk factor for predicting the degree of coronary stenosis in patients with CAD. Lp (a) level is related to the occurrence of MACE with the same level of LDL-C. |
Key words: coronary artery disease lipoprotein (a) coronary artery stenosis major adverse cardiovascular events |