中国老年瓣膜性心脏病脂蛋白(a)水平的不同特点分析

Lp(a)levels in elderly patients with valvular heart diseases in China

目的探究中国老年瓣膜性心脏病患者脂蛋白(a)水平在疾病分布、病因分布、合并冠心病的差异。方法纳入老年瓣膜性心脏病标准评估体系及优化治疗路径研究队列年龄≥65岁且超声心动图确诊的瓣膜重度狭窄和(或)反流的患者1320例,根据所有患者脂蛋白(a)水平分为升高组349例[脂蛋白(a)>300 mg/L或>140 nmol/L]和未升高组971例[脂蛋白(a)≤300 mg/L或≤140 nmol/L],分析脂蛋白(a)水平变化特点。结果本研究脂蛋白(a)升高比例为26.4%。升高组单纯主动脉瓣疾病、单纯二尖瓣疾病、单纯三尖瓣疾病比例与未升高组比较,差异有统计学意义(37.8%vs 28.7%,P=0.002;10.0%vs 16.4%,P=0.004;3.4%vs 6.7%,P=0.026)。在脂蛋白(a)升高组单纯主动脉瓣狭窄、单纯主动脉瓣反流、单纯二尖瓣反流患者中,退行性病因分别占有85.0%、93.8%、70.0%,明显高于其他病因,差异有统计学意义(P<0.05)。重度瓣膜病患者合并冠心病的患者脂蛋白(a)升高患者比例明显高于无冠心病患者(32.3%vs 24.4%,P=0.005)。升高组与未升高组性别比较,差异无统计学意义(P>0.05)。男性与女性患者脂蛋白(a)升高比例比较,差异无统计学意义(26.3%vs 26.6%,P>0.05)。结论老年瓣膜性心脏病患者脂蛋白(a)水平在疾病分类、疾病病因以及是否合并冠心病中具有一定差异性。

Objective To analyze the differences of Lp(a)levels in different disease distribution,etiologic distribution,and combined coronary artery disease in in elderly Chinese patients with valvular heart diseases.Methods A cohort of 1320 patients aged≥65 years with echocardiographically confirmed severe valve stenosis and/or regurgitation with standard evaluation system and optimized treatment were included in this study.According to their Lp(a)level,they were divided into 349 patients with increased Lp(a)(>300 mg/L or>140 nmol/L)and 971 patients without Lp(a)increasing(≤300 mg/L or≤140 nmol/L).Results The patients with increased Lp(a)accounted for 26.4%.Significant differences were seen in the proportions of simple aortic valve disease,simple mitral valve disease,simple tricuspid valve disease between those with elevated Lp(a)and those without elevated Lp(a)(37.8%vs 28.7%,P=0.002;10.0%vs 16.4%,P=0.004;3.4%vs 6.7%,P=0.026).The ratios of degenerative aortic stenosis and aortic insufficiency and simple mitral regurgitation were 85.0%,93.8%,and 70.0%,respectively in the patients with elevated Lp(a),much higher than those of other causes(P<0.05).The proportion of patients with elevated Lp(a)who had combined coronary artery disease was higher than the proportion of patients without elevated Lp(a)(32.3%vs 24.4%,P=0.005).There was no statistical difference in the ratio of different gender between the 2 groups(P>0.05).The patients with elevated Lp(a)was 26.3%in the male,and 26.6%in the female patients(P>0.05).ConclusionLp(a)level in elderly patients are variable in different valvular heart diseases,different disease etiology and with coronary heart diseases or not.