脂蛋白(a)与老年慢性心肾综合征的相关性研究

Association between lipoprotein(a)level and chronic cardio-renal syndrome in elderly patients

目的探讨脂蛋白(a)[lipoprotein(a),Lp(a)]水平和老年慢性心肾综合征(cardiorenal syndrome,CRS)的相关性。方法选取2017年12月至2019年10月于河北省人民医院心血管内科住院,年龄≥65岁的老年慢性心力衰竭(chronic heart failure,CHF)患者。根据估算的肾小球滤过率(estimate glomerular filtration rate,eGFR)水平,分为CRS组(eGFR<60 ml·min^-1·1.73 m^-2)和单纯CHF组(eGFR≥60 ml·min^-1·1.73 m^-2)。收集患者空腹血液指标、基础疾病情况和心脏超声指标,评估2组患者各临床指标和心肾功能指标[左心室射血分数(left ventricular ejection fraction,LVEF)和eGFR]的相关性,采用多因素logistic回归分析老年CRS的相关因素以及不同基础疾病亚组LP(a)水平和CRS的相关性。结果最终纳入172例研究对象,男性85例(49.4%),年龄79(71,84)岁。其中CRS组88例(51.2%),单纯CHF组84例(48.8%)。CRS组年龄[80(74,84)岁比74(70,82)岁]与LP(a)水平[222.0(112.0,445.3)mg/L比155.0(97.0,348.7)mg/L]均高于单纯CHF组(P<0.05)。在单纯CHF和CRS患者中,Lp(a)水平与LVEF(r=-0.155,P=0.043)、eGFR(r=-0.220,P=0.004)均负相关。对入组人群的2类高发基础疾病(冠心病和高血压)的亚组分析发现,冠心病组Lp(a)水平与LVEF负相关(r=-0.250,P=0.007),高血压组Lp(a)水平与eGFR负相关(r=-0.233,P=0.013)。多因素logistic回归分析结果显示年龄(OR=1.069,95%CI:1.017~1.124,P=0.009)和Lp(a)(OR=3.719,95%CI:1.339~10.326,P=0.012)是CRS的独立正相关因素。不同基础疾病亚组人群的logistic回归分析结果显示Lp(a)在冠心病(OR=3.207,95%CI:1.129~9.108,P=0.029)和高血压(OR=3.054,95%CI:1.086~8.587,P=0.034)亚组人群中是CRS的独立正相关因素。结论血清Lp(a)水平和老年CRS具有正相关性。

Objective To explore the relationship between lipoprotein(a)[Lp(a)]and chronic cardio-renal syndrome(CRS)in elderly patients.Methods Chronic heart failure(CHF)patients age≥65 years old,who hospitalized in the department of Cardiology of Hebei General Hospital from December 2017 to October 2019,were included in this study.According to the estimate glomerular filtration rate(eGFR)level,patients were divided into CRS group(eGFR<60 ml·min^-1·1.73 m^-2)and CHF group(eGFR≥60 ml·min^-1·1.73 m^-2).The blood index and basic disease information were collected and compared.Left ventricular ejection fraction(LVEF)were measured by echocardiography.The correlation between clinical indicators and cardio-renal function(LVEF and eGFR)was assessed.The multivariate logistic regression analysis was used to evaluate the related risk factors of CRS in elderly patients;subgroup logistic regression analysis was performed according to the basic disease of patients to assess the relationship between Lp(a)and CRS.Results A total of 172 elderly patients(85 males(49.4%),aged 79(71,84)years)were finally enrolled.Among them,88 cases(51.2%)were in CRS group and 84 cases(48.8%)were in CHF group.Age(80(74,84)years old vs.74(70,82)years old)and LP(a)levels(222.0(112.0,445.3)mg/L vs.155.0(97.0,348.7)mg/L)were significantly higher in the CRS group than in the CHF group(P<0.05).Lp(a)levels were negatively correlated with LVEF(r=-0.155,P=0.043)and eGFR(r=-0.220,P=0.004)in total cohort.In the subgroup analysis of patients with 2 high-incidence basic diseases(coronary heart disease and hypertension),Lp(a)was negatively correlated with LVEF(r=-0.250,P=0.007)in the coronary heart disease group,and negatively correlated with eGFR(r=-0.233,P=0.013)in the hypertension group.Multivariate logistic regression analysis showed that age(OR=1.069,95%CI:1.017-1.124,P=0.009)and Lp(a)(OR=3.719,95%CI:1.339-10.326,P=0.012)were independent correlates of CRS.The results of logistic regression analysis showed that Lp(a)was an independent correlative factor of CRS in the subgroups of coronary heart disease(OR=3.207,95%CI:1.129-9.108,P=0.029)and hypertension(OR=3.054,95%CI:1.086-8.587,P=0.034).Conclusion Serum Lp(a)level is independently related with CRS in elderly patients.