脂蛋白α、载脂蛋白B/A-1与颈动脉Crouse积分联合检测对冠状动脉病变程度的预测价值

Predictive Value of Combined Examination of Lipoprotein A,Apolipoprotein B/A-1 and Carotid Crouse Score in the Degree of Coronary Artery Disease

目的探讨联合检测人血清脂蛋白A、载脂蛋白B/A-1(Apo B/Apo A-1)及颈动脉Crouse积分判断冠状动脉病变严重程度的可行性。方法采用病例对照研究方法,选择2020年7月至2021年1月于我院行冠状动脉造影检查的患者122例,依据冠状动脉SYNTAX积分分为高危组(30例)和低危组(92例),比较两组基本临床资料、脂蛋白A、Apo B/Apo A-1、颈动脉Crouse积分以及其他实验室检查指标情况。多元线性回归及多因素Logistic回归用于评价脂蛋白A、Apo B/Apo A-1、Crouse积分与SYNTAX积分的相关性。受试者工作(ROC)曲线用于评价联合检测对冠状动脉高危病变的预测价值。结果在高危组和低危组患者中,糖尿病情况、脂蛋白A、Apo A-1、Apo B、Apo B/Apo A-1、Crouse积分及冠心病类型间差异具有统计学意义(P<0.05)。多元线性回归提示糖尿病情况、脂蛋白A、Apo B/Apo A-1、Crouse积分与冠状动脉SYNTAX积分呈正相关(标准化系数β分别为0.215,0.167,0.166,0.405,P<0.05)。多因素Logistic回归结果显示脂蛋白A、Apo B/Apo A-1、Crouse积分是冠状动脉高危病变的独立预测因素[OR分别为1.021(1.002,1.041),8.857(1.037,75.671),1.106(1.039,1.178),P<0.05]。ROC曲线结果证实联合检测脂蛋白A、Apo B/A-1、Crouse积分对预测SYNTAX高危具有很好的价值,ROC曲线下面积为0.826(95%CI:0.744,0.908,P<0.05)。约登指数最大为0.56,最佳截断值为0.15,敏感度和特异性分别为90%和66%。验证组包括11例高危病变和19例低危病变,经比对,联合检测的敏感度和特异性分别为72.73%和73.68%。结论脂蛋白A、Apo B/Apo A-1与颈动脉Crouse积分与冠状动脉病变程度相关,联合检测上述指标或有益于对冠状动脉病变程度的评估。

Objective To investigate the feasibility of the combined examination of human serum lipoprotein A[LP(a)],apolipoprotein B/A-1(Apo B/A-1)and carotid Crouse score for the severity of coronary artery disease.Methods This study was designed with a case-control study method.A total of 122 patients who took the coronary angiography in our hospital from July 2020 to December 2020 was involved.The patients was divided into 2 groups with the coronary SYNTAX score,30 in high-risk group and 92 in low-risk group.The basic clinical data,Lp(a)and Apo B/Apo A-1,carotid Crouse integral and other laboratory examination indexes of the two groups were compared.Multivariate linear regression and multivariate Logistic regression were used to evaluate the correlation between Lp(a),Apo B/Apo A-1,Crouse score and SYNTAX score.Receiver Operating Characteristic(ROC)was used to evaluate the predictive value of combination examination for high-risk coronary artery disease.Results There were significant differences in diabetes status,LP(a),APO A-1,APO B,APO B/A-1,Crouse score and coronary heart disease type between the high-risk group and the low-risk group(P<0.05).Multiple linear regression showed that diabetes,Lp(a),Apo B/A-1,Crouse score were positively correlated with SYNTAX score(normalized coefficientsβwere 0.215,0.167,0.166,0.405,P<0.05).Multivariate Logistic regression showed that Lp(a),Apo B/A-1 and Crouse score were independent predictors of coronary high-risk lesions[OR were 1.021(1.002,1.041),8.857(1.037,75.671),1.106(1.039,1.178),P<0.05].ROC results confirmed that combined examination of Lp(a),Apo B/a-1 and Crouse score had good value in predicting SYNTAX.The area under ROC curve was 0.826(95%CI:0.744,0.908,P<0.05).The maximum Youden index was 0.56,the optimal cutoff value was 0.15,and the sensitivity and specificity were 90%and 66%respectively.The validation group included 13 high-risk lesions and 23 low-risk lesions.By comparison,the sensitivity and specificity of the combined detection were 84.62%and 73.91%respectively.Conclusion Lp(a),Apo B/A-1 and carotid Crouse score are correlated with the degree of coronary artery disease.Combined examination of the above indexes may be beneficial to the assessment of the degree of coronary artery disease.