2020 年3 期 第28 卷
论著![HTML下载 HTML下载](/Areas/201911120101/Content/img/icon_html.png)
![PDF下载 PDF下载](/Areas/201911120101/Content/img/icon_pdf.png)
脂蛋白相关磷脂酶 A2 与冠心病患者踝臂指数、心率变异性的相关性研究
Correlations of lipoprotein-associated phospholipase A2 with ankle-brachial index andheart rate variability in patients with coronary heart disease
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
- Units:
- 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
- Keywords:
- Coronary heart disease;Lipoprotein-associated phospholipase A2;Ankle-brachial Index;Heart ratevariability
- CLC:
- R 541.4
- DOI:
- DOI:10.3969/j.issn.1008-5971.2020.03.010
- Funds:
- 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。
Abstract:
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.
ReferenceList: