急性ST段抬高型心肌梗死患者脂蛋白相关磷脂酶A_(2)、脂蛋白a和糖化血红蛋白水平与颈动脉粥样硬化的相关性

Association of lipoprotein-associated phospholipase A_(2), lipoprotein a, and glycosylated hemoglobin levels with carotid atherosclerosis in patients with acute ST-segment elevation myocardial infarction

目的探讨分析急性ST段抬高型心肌梗死(STEMI)患者脂蛋白相关磷脂酶A2(Lp-PLA_(2))、脂蛋白a[Lp(a)]和糖化血红蛋白(HbA1c)水平与颈动脉粥样硬化的相关性。方法选取2021年1月至12月潍坊市人民医院收治的221例STEMI患者为病例组,根据颈动脉狭窄程度分为轻度狭窄(n=81)、中度狭窄(n=87)和重度狭窄(n=53)3个亚组,另取同期体检中心健康者70人为对照组,检测两组的Lp-PLA_(2)、Lp(a)和HbA1c水平。采用Spearman相关性分析观察各指标与颈动脉狭窄程度的相关性,采用多因素logistic回归分析各指标与颈动脉病变的关系。结果经单因素分析,病例组的Lp-PLA_(2)、Lp(a)和HbA1c水平高于对照组,差异有统计学意义(P<0.05)。轻度狭窄、中度狭窄和重度狭窄3个亚组患者的Lp-PLA_(2)、Lp(a)和HbA1c水平比较,差异有统计学意义(P<0.05)。Spearman相关性分析显示,Lp-PLA_(2)、Lp(a)和HbA1c水平与狭窄程度呈正相关(r=0.422,0.349,0.305,均P<0.05)。多因素logistic回归分析结果显示,患者体内Lp-PLA_(2)(β=0.027,OR=1.027,95%CI:1.016~1.038)、Lp(a)(β=0.007,OR=1.007,95%CI:1.016~1.038)、HbA1c(β=0.462,OR=1.588,95%CI:1.156~2.180)水平是影响颈动脉狭窄程度的独立危险因素(P<0.05)。结论STEMI患者体内Lp-PLA_(2)、Lp(a)和HbA1c水平越高,颈动脉粥样硬化程度越严重。

Objective To investigate the relationship between lipoprotein-associated phospholipase A2(Lp-PLA_(2)),lipoprotein a(Lp[a])and HbA1c levels and carotid atherosclerosis in patients with acute St-segment elevation myocardial infarction(STEMI).Methods A total of 221 STEMI patients admitted to Weifang People's Hospital from January to December 2021 were selected as the case group and divided into three subgroups according to the degree of carotid artery stenosis:mild stenosis(n=81),moderate stenosis(n=87)and severe stenosis(n=53).Another 70 healthy subjects in physical examination centers during the same period were selected as control group.Lp-PLA_(2),Lp(a)and HbA1c levels were detected in both groups.Spearman correlation analysis was used to observe the correlation between each index and the degree of carotid artery stenosis,and multivariate logistic regression was used to analyze the relationship between each index and carotid artery lesions.Results By univariate analysis,the levels of Lp-PLA_(2),Lp(a)and HbA1c in the case group were higher than those in the control group,and the differences were statistically significant(P<0.05).The levels of LP-PLA_(2),Lp(a)and HbA1c in three subgroups with mild stenosis,moderate stenosis and severe stenosis were significantly different(P<0.05).Spearman correlation analysis showed that Lp-PLA_(2),Lp(a)and HbA1c levels were positively correlated with the degree of stenosis(r=0.422,0.349,0.305,all P<0.05).Multivariate logistic regression analysis showed that LP-PLA_(2)(β=0.027,OR=1.027,95%CI:1.016-1.038),Lp(a)(β=0.007,OR=1.007,95%CI:1.016-1.038)and HbA1c(β=0.462,OR=1.588,95%CI:1.156-2.180)were independent risk factors for carotid artery stenosis(P<0.05).Conclusion The higher the levels of LP-PLA_(2),Lp(a),and HbA1c in STEMI patients,the greater the degree of carotid atherosclerosis.