老年ST段抬高型心肌梗死患者脂蛋白相关磷脂酶A2水平及对预后的影响

Effect of lipoprotein-related phospholipase A2 level on outcome in elderly STEMI patients

目的探讨老年ST段抬高型心肌梗死(STEMI)患者脂蛋白相关磷脂酶A2(Lp-PLA2)水平及对预后的影响。方法收集2017年6月~2018年6月河南科技大学第一附属医院心内科住院的STEMI患者702例,根据随访结束时生存状况分为死亡组52例和存活组650例。又根据Lp-PLA2的最佳截断值分为高水平组136例,低水平组566例。收集患者一般基线资料、既往史和实验室检测指标及随访结束时患者的生存状况。Cox多因素回归分析影响STEMI患者死亡的危险因素,ROC曲线评估Lp-PLA2预测STEMI患者死亡的价值,比较高水平组与低水平组存活率。结果2组Killip分级比较,差异有统计学意义(P<0.01)。死亡组年龄、体质量指数、心率、恶性心律失常、心脏骤停、既往PCI、脑卒中、血肌酐、白细胞计数、血清钾、肌钙蛋白I、肌酸激酶同工酶和Lp-PLA2水平明显高于存活组,血红蛋白水平明显低于存活组,差异有统计学意义(P<0.05,P<0.01)。Cox多因素回归模型显示,年龄、体质量指数、恶性心律失常、心脏骤停、Killip分级、既往PCI、心力衰竭、脑卒中、肌钙蛋白I、肌酸激酶同工酶和Lp-PLA2均为STEMI患者出院后24个月内死亡的危险因素(P<0.05,P<0.01)。Lp-PLA2预测STEMI患者死亡的最佳截断值为201.5μg/L,敏感性为88.5%,特异性为74.3%(95%CI:0.815~0.914,P<0.01)。高水平组存活率明显低于低水平组(OR=19.291,95%CI:9.851~37.763,P<0.01)。结论Lp-PLA2高水平STEMI患者24个月存活率明显降低,Lp-PLA2有望成为评估STEMI患者不良预后的有效指标。

Objective To study the effect of Lp-PLA2 on the outcome in elderly STEMI patients.Methods Seven hundred and two STEMI patients admitted to our hospital from June 2017 to June 2018 were divided into death group(n=52)and survival group(n=650)according to their survival at the end of follow-up and into high Lp-PLA2 level group(n=136)and low Lp-PLA2 level group(n=566)according to the optimal cut-off value of Lp-PLA2.Their general baseline data,past history diseases,laboratory testing parameters and survival rate were recorded at the end of follow-up.The risk factors for death of elderly STEMI patients were analyzed by multivariate Cox regression analysis.The value of Lp-PLA2 in predicting the death of STEMI patients was analyzed by ROC curve analysis.The survival rates were compared between high Lp-PLA2 level group and low Lp-PLA2 level group.Results Significant difference was detected in the Killip classification between death group and survival group(P<0.01).The age was significantly older,the BMI and heart rate,incidence of malignant arrhythmia,cardiac arrest,PCI,cerebral stroke,serum levels of creatinine,potassium,troponin I,creatine kinase isoenzyme,Lp-PLA2 were significantly higher and the number of white blood cells was significantly larger while the serum hemoglobin level was significantly lower in death group than in survival group(P<0.05,P<0.01).Multivariate Cox regression analysis showed that age,BMI,malignant arrhythmia,cardiac arrest,Killip classification,PCI,HF,cerebral stroke and serum levels of troponin I,CK-MB and Lp-PLA2 were the risk factors for death of elderly STEMI patients after 24 months of discharge(P<0.05,P<0.01).The optimal cut-off value of Lp-PLA2 in predicting the death of elderly STEMI patients was 201.5μg/L with a sensitivity of 88.5% and a specificity of 74.3%(95%CI:0.815-0.914,P<0.01).The survival rate was significantly lower in high Lp-PLA2 level group than in low Lp-PLA2 level group(OR=19.291,95%CI:9.851-37.763,P<0.01).Conclusion High Lp-PLA2 level can reduce the 24-month survival rate of elderly STEMI patients and is expected to become an effective marker for assessing their poor outcome.