血清脂蛋白(a)水平与绝经后女性新发冠心病及其严重程度的相关性研究

Correlation between serum lipoprotein(a)level andthe occurrence and severity of new-onset coronary artery disease in postmenopausal women

目的研究血清脂蛋白(a)[Lp(a)]是否可作为预测绝经后女性新发冠心病及其严重程度的生物标志物。方法纳入2017年6月至2019年6月于沧州市人民医院住院的首次出现胸闷、胸痛症状的绝经后女性283例,根据冠状动脉造影结果分为冠心病组136例和非冠心病组147例。根据Gensini评分(GS)将冠心病组又分为低GS组(GS<18,47例)、中GS组(19≤GS≤35,44例)和高GS组(GS>36,45例)。收集患者一般临床资料和血清学相关指标;进行多因素logistic回归分析影响绝经后女性新发冠心病的危险因素;采用Pearson相关分析血清Lp(a)水平与冠状动脉病变严重程度的关系;绘制受试者工作特征(ROC)曲线评价绝经后女性血清Lp(a)水平对新发冠心病的预测价值。结果冠心病组患者血清Lp(a)水平明显高于非冠心病组[(256.51±54.09)mg/L比(109.68±28.13)mg/L,t=28.504,P=0.000]。多因素logistic回归分析提示,血清Lp(a)水平是绝经后女性新发冠心病的独立危险因素(OR=4.579,95%CI:1.680~7.137,P=0.000)。血清Lp(a)水平随GS增加而显著升高(t=11.092,P=0.000),且与GS呈独立正相关(r=0.311,P<0.001)。血清Lp(a)水平预测绝经后女性新发冠心病的ROC曲线下面积为0.777(95%CI:0.716~0.837,P<0.05),最佳临界值243.50 mg/L,敏感度76.5%,特异度87.1%。结论血清Lp(a)水平是预测绝经后女性新发冠心病存在及其严重程度的独立危险因子,提示Lp(a)可能是预防和治疗绝经后女性新发冠心病的血脂干预新靶点。

Objective To study whether serum lipoprotein(a)[Lp(a)]can be used as a biomarker for predicting new-onset coronary artery disease(CAD)and its severity in postmenopausal women.Methods A total of 283 postmenopausal women who were hospitalized in Cangzhou People’s Hospital from June 2017 to June 2019 who had symptoms of chest tightness and chest pain for the first time were enrolled,subjects were divided into CAD group(n=136)and non-CAD group(n=147)according to coronary angiography results.According to the Gensini score(GS),the patients with CAD were divided into three subgroups:low GS group(GS<18,n=47),middle GS group(19≤GS≤35,n=44)and high GS group(GS>36,n=45).The general clinical data and serological related indexes of the patients were collected.Multivariate logistic regression analysis was used to analyze the risk factors of new-onset CAD in postmenopausal women;Pearson correlation analysis was used to analyze the relationship between serum Lp(a)levels and severity of CAD;The receiver operating characteristic curve was plotted to evaluate the predictive value of serum Lp(a)levels in postmenopausal women for new CAD.Results The level of serum Lp(a)was significantly higher in CAD group than that in non-CAD group[(256.51±54.09)mg/L vs.(109.68±28.13)mg/L,t=28.504,P=0.000].Multivariate logistic regression analysis showed that serum Lp(a)level was an independent predictor of new-onset CAD in postmenopausal women(OR=4.579,95%CI:1.680-7.137,P=0.000).The serum Lp(a)level was significantly elevated according to the tertiles of GS(t=11.092,P=0.000).Pearson correlation analysis indicated that the Lp(a)was positively related with the GS(r=0.311,P<0.001).The area under the receiver operating characteristic curve of serum Lp(a)in predicting new-onset CAD in postmenopausal women was 0.777(95%CI:0.716-0.837,P<0.05),the optimal critical value was 243.50 mg/L,the sensitivity was 76.5%,and the specificity was 87.1%.Conclusions The serum Lp(a)level is an independent risk factor for predicting the presence and its severity of new-onset CAD in postmenopausal women,suggesting that Lp(a)may be a new target for blood lipid intervention for the prevention and treatment in such patients.