Lp(a)对老年慢性心力衰竭患者发生心房颤动的预测价值

Predictive value of Lp (a) on atrial fibrillation in elderly patients with chronic heart failure

目的探讨血清脂蛋白a[Lp(a)]对老年慢性心力衰竭(CHF)患者发生心房颤动(AF)的预测价值。方法本项研究选择2014年2月至2017年2月于郑州大学第二附属医院老年医学科就诊的老年CHF患者162例,根据有无房颤病史及入院时心电图检查结果,47例患者为CHF合并AF(AF组),115例患者未合并房颤(非AF组)。检查并比较两组患者血液生化指标、心功能指标以及Lp(a)水平的差异,并采用受试者工作特征(ROC)曲线确定Lp(a)的诊断价值。结果入院时,AF组患者糖化血红蛋白、三酰甘油、低密度脂蛋白-胆固醇和Lp(a)水平以及心功能指标与非AF组患者比较,差异有统计学意义(P均<0.05)。经多因素logistic回归分析,Lp(a)水平升高是CHF患者发生AF的独立危险因素(P<0.05)。经ROC曲线分析,血清Lp(a)水平判断CHF患者是否合并AF的曲线下的面积为0.826(95%CI:0.748～0.903,P<0.01),截断值为345 mg/L。结论血清Lp(a)水平可作为老年慢性心力衰竭患者发生心房颤动风险的预测因子。

Objective To investigate the predictive value of lipoprotein a[Lp(a)]on atrial fibrillation(AF)in elderly patients with chronic heart failure(CHF).Methods In this study,162 elderly patients with CHF who were admitted to the Department of Geriatrics of the Second Affiliated Hospital of Zhengzhou University from February 2014 to February 2017 were selected.According to the history of atrial fibrillation and electrocardiogram at admission,47 patients were CHF.Combined with AF(AF group),115 patients did not have atrial fibrillation(non-AF group).The differences of blood biochemical parameters,cardiac function indexes and Lp(a)levels between the two groups were examined and compared,and the diagnostic value of Lp(a)was determined by the receiver operating characteristic(ROC)curve.Results At admission,the levels of glycated hemoglobin,triglyceride,low-density lipoprotein-cholesterol and Lp(a),and cardiac function in the AF group were significantly different from those in the non-AF group(P<0.05).After multivariate logistic regression analysis,elevated Lp(a)levels were independent risk factors for AF in patients with CHF(P<0.05).According to the ROC curve analysis,the serum Lp(a)level was used to determine whether the area under the curve of CHF patients with AF was 0.826(95%CI:0.748~0.903,P<0.01),and the cutoff value was 345 mg/L.Conclusion Serum Lp(a)levels can be used as predictors of risk of atrial fibrillation in elderly patients with CHF.