作者：刘向阳，李爱华，唐良秋

单位：

512026 广东省韶关市，汕头大学附属粤北人民医院心血管内科；通信作者：唐良秋，E-mail：TLQ_55048@sina.com

单位（英文）：

Department of Cardiovascular Medicine，North Guangdong People's Hospital Affiliated to Shantou University，Shaoguan512026， China；Corresponding author：TANG Liangqiu，E-mail：TLQ_55048@sina.com

关键词：

冠心病；脂蛋白相关磷脂酶 A2；踝臂指数；心率变异性

关键词（英文）：

Coronary heart disease；Lipoprotein-associated phospholipase A2；Ankle-brachial Index；Heart ratevariability

中图分类号：

R 541.4

DOI：

DOI：10.3969/j.issn.1008-5971.2020.03.010

基金项目：

基金项目：广东省韶关市医药卫生科研计划项目（Y17015）；广东省韶关市科技局计划项目（2017CX/K011）

摘要：

背景　踝臂指数（ABI）可预测冠状动脉狭窄，心率变异性（HRV）降低与冠心病（CHD）的进展有关，脂蛋白相关磷脂酶 A2（Lp-PLA2）是 CHD 患者冠状动脉狭窄的危险因素，但三者之间的关系目前尚不明确。目的　分析 Lp-PLA2 与 CHD 患者 ABI、HRV 的相关性，并分析 Lp-PLA2 对 CHD 患者 ABI 及 HRV 异常的预测价值。方法　选取 2016 年 4 月—2019 年 1 月汕头大学附属粤北人民医院心血管内科确诊的非 CHD 患者 292 例作为 A 组，同期确诊的 CHD 患者 389 例作为 B 组。比较两组患者一般资料、实验室检查指标、血脂指标及 ABI、HRV；变量间的相关性分析采用 Pearson 偏相关及多元线性回归分析；绘制 ROC 曲线以评价 Lp-PLA2 对 CHD 患者 ABI 及 HRV 异常的预测价值。结果　（1）两组患者高血压病史、体质指数（BMI）、三酰甘油（TG）、载脂蛋白 B（ApoB）比较，差异无统计学意义（P>0.05）；B 组患者年龄、有 2 型糖尿病病史者所占比例、同型半胱氨酸（Hcy）、Lp-PLA2、糖化血红蛋白（HbA 1c ）、超敏C反应蛋白（hs-CRP）、脂蛋白a〔LP（a）〕高于A组，总胆固醇（TC）、载脂蛋白A（ApoA）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、ABI 及全部窦性心搏 RR 间期的标准差（SDNN）低于A组（P<0.05）。（2）Lp-PLA2未进入多元线性回归方程。Pearson偏相关分析结果显示，ABI与CHD（r=-0.147）、Hcy（r=-0.082）呈负相关，与 BMI（r=0.119）、SDNN（r=0.157）呈正相关（P<0.05）。多元线性回归分析结果显示，ABI与CHD（ β =-0.50）和Hcy（ β =-0.01）呈负相关，与BMI（ β =0.004）和SDNN（ β =0.001）呈正相关（P<0.05）。（3）Pearson 偏相关分析结果显示，SDNN 与 Lp-PLA2（r=-0.098）、hs-CRP（r=-0.123）呈负相关（P<0.05）。多元线性回归分析结果显示，SDNN 与 CHD 患者 LP-PLA2（ β =-0.040）、hs-CRP（ β =-4.388）负相关，与 ABI（ β =43.301）呈正相关（P<0.05）。（4）ROC曲线显示，Lp-PLA2预测CHD患者ABI异常的曲线下面积（AUC）为0.583〔95%CI （0.480，0.687）〕，灵敏度为0.84、特异度为0.38；Lp-PLA2预测CHD患者SDNN异常的AUC为0.656〔95%CI（0.600，0.712）〕，灵敏度为 0.76，特异度为 0.48。结论　CHD 患者 Lp-PLA2 升高，ABI、HRV 降低；Lp-PLA2 与 CHD 患者 HRV 呈负相关且对 CHD 患者 HRV 异常有一定的预测价值，但其与 CHD 患者 ABI 无关，而 ABI 与 CHD 患者 HRV 呈正相关。

英文摘要：

Background　Ankle-brachial index（ABI）can predict coronary artery stenosis，decrease of heart ratevariability（HRV）is associated with progress of coronary heart disease（CHD），lipoprotein-associated phospholipase A2（Lp-PLA2）is the risk factor of coronary artery stenosis in patients with CHD，however，interrelationship of the above threeis not yet clear. Objective　To analyze the correlations of Lp-PLA2 with ABI and HRV in patients with CHD，and to analyzethe predictive value of Lp-PLA2 on ABI abnormity as well as HRV abnormity in patients with CHD. Methods　From April2016 to January 2019，292 non-CHD patients were selected as A group in the Department of Cardiovascular Medicine，NorthGuangdong People's Hospital Affiliated to Shantou University，meanwhile 389 patients with CHD were selected as B group.Comparison of general information，laboratory examination results，blood lipid parameters，ABI and HRV was conductedbetween the two groups；Pearson partial correlation analysis and multiple linear regression analysis were used to analyze thecorrelations between variables，moreover ROC curve was drawn to evaluate the predictive value of Lp-PLA2 on ABI abnormity aswell as HRV abnormity in patients with CHD. Results　（1）No statistically significant difference of history of hypertension，BMI，TG or ApoB was found between the two groups（P>0.05）；age，proportion of patients with history of diabetes，Hcy，Lp-PLA2，HbA 1c ，hs-CRP and Lp（a）in B group were statistically significantly higher than those in A group，while TC，ApoA，HDL-C，LDL-C，ABI and SDNN in B group were statistically significantly lower than those in A group（P<0.05）.（2）Lp-PLA2 did not enter into the multiple linear regression analysis. Pearson partial correlation analysis results showed that，ABIwas negatively correlated with CHD（r=-0.147）and Hcy（r=-0.082），respectively，but was positively correlated with BMI（r=0.119）and SDNN（r=0.157），respectively（P<0.05）. Multiple linear regression analysis results showed that，ABIwas negatively correlated with CHD（ β =-0.50）and Hcy（ β =-0.01），respectively，but was positively correlated with BMI（ β =0.004） and SDNN（ β =0.001），respectively（P<0.05）.（3）Pearson partial correlation analysis results showedthat，SDNN was negatively correlated with Lp-PLA2 （r=-0.098）and hs-CRP（r=-0.123），respectively（P<0.05）.Multiple linear regression analysis results showed that，SDNN was negatively correlated with LP-PLA2（ β =-0.040） and hs-CRP（ β =-4.388），respectively，but was positively correlated with ABI（ β =43.301）（P<0.05）.（4） ROC curvesindicated that，AUC，sensitivity and specificity of Lp-PLA2 in predicting ABI abnormity in patients with CHD was 0.583〔95%CI（0.480，0.687）〕，0.84 and 0.38，respectively；AUC，sensitivity and specificity of Lp-PLA2 in predictingSDNN abnormity in patients with CHD was 0.656〔95%CI（0.600，0.712）〕，0.76 and 0.48，respectively. ConclusionLp-PLA2 increases but ABI and HRV decrease in patients with CHD；Lp-PLA2 is negatively correlated with HRV and it haspredictive value on HRV abnormity in patients with CHD to some extent，however Lp-PLA2 is not significantly correlated withABI in patients with CHD，but there is positive correlation between ABI and HRV.

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