血浆脂蛋白相关磷脂酶A2对慢性肾脏病患者心血管事件的预测价值

Value of Plasma Lipoprotein Associated Phospholipase A2 in Predicting Cardiovascular Events in Patients with Chronic Kidney Disease

目的:探讨血浆脂蛋白相关磷脂酶A2(LP-PLA2)对慢性肾脏病(CKD)患者心血管事件的预测价值。方法:回顾性分析2013年7月-2017年11月在东莞东华医院治疗的200例CKD患者资料。收集所有患者血清指标,包括总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、甲状旁腺激素(PTH)、超敏C反应蛋白(hs-CRP)、缺血修饰白蛋白(IMA)、肌钙蛋白T(cTnT)、LP-PLA2含量,并采用Framingham评分系统评估所有患者心血管疾病风险。根据LPPLA2检测结果将患者分为高LP-PLA2组和正常LP-PLA2组,比较两组一般资料、血清指标、Framingham评分及主要心血管不良事件(MACE)的发生情况。采用Pearson检验分析LP-PLA2与血清指标、Framingham评分的相关性,绘制ROC曲线分析LP-PLA2对CKD患者MACE的预测价值。结果:高LP-PLA2组年龄大于正常LP-PLA2组,且高血压、心血管病史的占比高于LP-PLA2组(P<0.05)。高LP-PLA2组患者HDL-C低于正常LP-PLA2组,PTH、hs-CRP、IMA、cTnT、Framingham评分高于正常LP-PLA2组(P<0.05)。LP-PLA2与HDL-C呈负相关(r=-0.436,P<0.05),与PTH、hs-CRP、IMA、cTnT、Framingham评分呈正相关(r=0.377、0.628、0.566、0.382、0.572,P<0.05)。高LP-PLA2组的MACE发生率为35.2%(25/71),高于正常LP-PLA2组的11.7%(13/112)(P<0.05)。ROC曲线分析显示,LP-PLA2预测MACE的曲线下面积为0.880(95%CI:0.810,0.950)。结论:LP-PLA2可能与CKD患者冠脉病变密切相关,通过监测LP-PLA2水平变化对MACE的发生具有显著的预测价值。

Objective:To explore the value of plasma lipoprotein associated phospholipase A2(LP-PLA2)in predicting cardiovascular events in patients with chronic kidney disease(CKD).Method:A total of 200 patients with CKD treated in Dongguan Donghua Hospital from July 2013 to November 2017 were analyzed retrospectively.Serum indexes including total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),parathyroid hormone(PTH),high sensitivity C-reactive protein(hsCRP),ischemia modified albumin(IMA),troponin T(cTnT)and LP-PLA2 were measured.The risk of cardiovascular disease was evaluated by Framingham scoring system.According to the results of LP-PLA2 test,the patients were divided into high LP-PLA2 group and normal LP-PLA2 group.The basic data,serum indexes,Framingham score and the incidence of major adverse cardiovascular events(MACE)were compared between the two groups.Pearson test was used to analyze the correlation between LP-PLA2,serum indexes and Framingham score,and ROC curve was drawn to analyze the predictive value of LP-PLA2 on MACE in patients with CKD.Result:The age of high LP-PLA2 group was older than that in normal LP-PLA2 group,and the proportion of hypertension and cardiovascular history was higher than that in LP-PLA2 group(P<0.05).HDL-C in high LP-PLA2 group was lower than that in normal LP-PLA2 group,and PTH,hs-CRP,IMA,cTnT and Framingham scores were higher than those in normal LP-PLA2 group(P<0.05).LP-PLA2 was negatively correlated with HDL-C(r=-0.436,P<0.05),and positively correlated with PTH,hs-CRP,IMA,cTnT and Framingham score(r=0.377,0.628,0.566,0.382,0.572,P<0.05).The incidence of MACE in high LP-PLA2 group was 35.2%(25/71),which was higher than 11.7%(13/112)in normal LP-PLA2 group(P<0.05).ROC curve analysis showed that the area under the curve of MACE predicted by LPPLA2 was 0.880(95%CI:0.810,0.950).Conclusion:LP-PLA2 may be closely related to coronary artery disease in patients with CKD.Monitoring the level of LP-PLA2 has significant predictive value for MACE.