老年社区人群脂蛋白(a)与主要心血管不良事件的相关性研究

Correlation between lipoprotein(a)and major adverse cardiovascular events in elderly community population

目的探讨北京社区老年人群脂蛋白(a)[Lp(a)]水平对主要不良心血管事件(MACE)的预测价值。方法纳入2007年9月至2009年1月北京市石景山、海淀、大兴多个社区当地常住老年健康体检居民833例,末次随访时间2017年至2018年,中位随访时间9.5(8.7,10.5)年,失访188例,最终纳入645例,根据随访期间是否发生MACE分为MACE组130例,非MACE组515例。采用多元线性回归分析Lp(a)的相关影响因素,采用Cox回归分析评估Lp(a)与MACE的相关性。结果随访期间共发生MACE为20.2%。MACE组年龄、男性、吸烟、糖尿病、高血压、收缩压明显高于非MACE组,他汀类药物、估算的肾小球滤过率(eGFR)、HDL-C水平明显低于非MACE组,差异有统计学意义(P<0.05,P<0.01)。多元线性回归分析显示,Lp(a)水平与男性(β=-0.188,95%CI:-0.335~-0.051,P=0.017)、TG(β=-0.235,95%CI:-0.379~-0.091,P=0.002)、eGFR(β=-0.456,95%CI:-0.897~-0.011,P=0.039)呈负相关,与TC(β=0.213,95%CI:0.057~0.352,P=0.006)呈正相关。Cox回归分析显示,校正相关因素后,Lp(a)水平与MACE发生无显著相关性(P>0.05)。结论Lp(a)对老年人群MACE的预测价值需要进一步验证。

Objective To investigate the predictive value of lipoprotein(a)[Lp(a)]level for major adverse cardiovascular events(MACE)in Beijing community-dwelling elderly.Methods From September 2007 to January 2009,833 elderly residents who attended physical examination in Shijingshan,Haidian and Daxing communities in Beijing were enrolled in this study.The last follow-up was during 2017 and 2018,and the median follow-up period was 9.5(8.7,10.5)years.Since 188 cases were lost during follow-up,645 cases were finally included.According to occurrence of MACE during the follow-up period,130 cases were assigned into the MACE group and 515 cases into the non-MACE group.Multiple linear regression analysis was used to analyze the relevant influencing factors of Lp(a),and Cox regression analysis was employed to evaluate the correlation between Lp(a)and MACE.Results During the follow-up period,the incidence of MACE was 20.2%.The patients from the MACE group had older age,larger proportions of male,smoking history,diabetes and hypertension,higher SBP,lower usage of statins,and lower eGFR and HDL-C level than those in the non-MACE group(P<0.05,P<0.01).Multiple linear regression analysis showed that Lp(a)level was negatively correlated with male(β=-0.188,95%CI:-0.335--0.051,P=0.017),TG level(β=-0.235,95%CI:-0.379--0.091,P=0.002)and eGFR(β=-0.456,95%CI:-0.897--0.011,P=0.039),and positively with TC level(β=0.213,95%CI:0.057-0.352,P=0.006).Cox regression analysis displayed that after adjustment of re-lated factors,no significant correlation was found between Lp(a)level and occurrence of MACE(P<0.05).Conclusion The predictive value of Lp(a)for MACE in the elderly population needs further validation.