Lp(a)、apo B/apo A-1比值对AMI患者介入治疗后发生主要不良心血管事件的预测价值

Predictive values of Lp(a)and apoB/apoA-1 ratio for the occurrence of MACE in patients with AMI after interventional therapy

目的探讨脂蛋白(a)[Lp(a)]、载脂蛋白B(apo B)/载脂蛋白A-1(apo A-1)比值对急性心肌梗死(AMI)患者介入治疗后发生主要不良心血管事件(MACE)的预测价值。方法选取行介入治疗的AMI患者200例,根据介入治疗后6个月是否发生MACE分为MACE组(47例)、无MACE组(153例)。收集所有患者的基本资料和入院时的实验室检测结果,同时检测Lp(a)、apo B、apo A-1水平。采用Pearson相关分析评估Lp(a)、apo B/apo A-1比值与氨基末端B型钠尿肽原(NT-proBNP)、左心室射血分数(LVEF)、低密度脂蛋白胆固醇(LDL-C)的相关性。采用Cox回归分析评估AMI患者介入治疗后发生MACE的影响因素。采用受试者工作特征(ROC)曲线评价Lp(a)、apo B/apo A-1比值判断MACE发生的效能。结果MACE组Lp(a)、apo B/apo A-1比值高于无MACE组(P<0.05)。Pearson相关分析结果显示,Lp(a)、apo B/apo A-1比值与NT-proBNP、LDL-C均呈正相关(P<0.05),与LVEF呈负相关(P<0.05)。Cox回归分析结果显示,Lp(a)、apo B/apo A-1比值是AMI介入治疗后发生MACE的影响因素[风险比(HR)分别为2.347、2.476,95%可信区间(CI)分别为1.459~3.774、1.561~3.928]。ROC曲线分析结果显示,Lp(a)、apo B/apo A-1比值单项检测和联合检测模型判断AMI患者介入治疗后发生MACE的曲线下面积(AUC)分别为0.798、0.821、0.898。结论Lp(a)、apoB/apo A-1比值升高是AMI患者介入治疗后发生MACE的危险因素,在AMI患者介入治疗的预后评估中有一定的临床意义。

Objective To investigate the predictive values of lipoprotein(a)[Lp(a)]and apolipoprotein B(apo B)/apolipoprotein A-1(apo A-1)ratio for the occurrence of major adverse cardiovascular event(MACE)in patients with acute myocardial infarction(AMI)after interventional therapy.Methods A total of 200 patients with AMI undergoing interventional therapy were enrolled.According to the occurrence of MACE for 6 months after interventional therapy,they were classified into MACE group(47 cases)and non-MACE group(153 cases).Baseline data and clinical laboratory results were collected,and Lp(a),apo B and apo A-1 were determined.Pearson correlation analysis was used to analyze the correlation between Lp(a),apo B/apo A-1 ratio and aminoterminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF)and low-density lipoprotein cholesterol(LDL-C).Cox regression analysis was used to analyze the influencing factors of MACE in AMI patients after interventional therapy.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of Lp(a)and apo B/apo A-1 ratio combined determination for the occurrence of MACE after interventional therapy.Results Lp(a)and apo B/apo A-1 ratio in MACE group were higher than those in non-MACE group(P<0.05).The results of Pearson correlation analysis showed that Lp(a)and apo B/apo A-1 ratio were positively correlated with NT-proBNP and LDL-C(P<0.05),and they were negatively correlated with LVEF(P<0.05).Cox regression analysis showed that Lp(a)and apo B/apo A-1 ratio were the influencing factors of MACE[hazard ratios(HR)were 2.347 and 2.476,95%confidence intervals(CI)were 1.459-3.774 and 1.561-3.928,respectively].The results of ROC curve analysis showed that the areas under curves(AUC)of Lp(a),apo B/apo A-1 ratio single determinations and combined determination for the occurrence of MACE in AMI patients after interventional therapy were 0.798,0.821 and 0.898,respectively.Conclusions The high levels of Lp(a)and apo B/apo A-1 ratio are independent risk factors for MACE in AMI patients after interventional therapy.The combined determination has a high predictive value for the prognosis of interventional therapy in AMI patients.