脂蛋白(a)及红细胞分布宽度与非瓣膜性心房颤动患者合并急性缺血性卒中的相关性研究

Correlation between lipoprotein(a)and red blood cell distribution width and acute ischemic stroke in patients with non-valvular atrial fibrillation

目的探讨脂蛋白(a)[Lp(a)]及红细胞分布宽度(RDW)与非瓣膜性心房颤动(NVAF)患者合并急性缺血性卒中(AIS)的关系。方法选择2020年4月至2023年4月于安徽医科大学第三附属医院住院的313例NVAF患者的临床资料进行回顾性分析。根据是否合并AIS将患者分为卒中组(150例,NVAF合并AIS患者)和非卒中组(163例,单纯NVAF患者)。比较两组临床资料的差异,采用logistic回归分析Lp(a)、RDW与NVAF患者合并AIS的相关性,绘制受试者工作特征(ROC)曲线以评估Lp(a)、RDW对AIS的预测价值。结果卒中组平均年龄、高血压、持续性房颤病史比例及CHA2DS2-VASc评分均高于非卒中组,差异均有统计学意义(P<0.05)。卒中组Lp(a)及RDW均高于非卒中组,差异均有统计学意义(P<0.05),多因素logistic回归分析结果显示,Lp(a)(OR=1.003,95%CI 1.002~1.005,P<0.01)和RDW(OR=1.913,95%CI 1.373~2.665,P<0.01)为NVAF患者合并AIS的独立危险因素。ROC曲线显示,Lp(a)、RDW及Lp(a)联合RDW预测NVAF患者合并AIS的曲线下面积分别为0.685、0.695、0.755。结论Lp(a)和RDW是NVAF患者合并AIS的独立危险因素,两者联合对NVAF患者合并AIS具有一定的预测价值。

Objective To investigate the relationship between lipoprotein(a)[Lp(a)]and red blood cell distribution width(RDW)and acute ischemic stroke(AIS)in patients with non-valvular atrial fibrillation(NVAF).Methods The clinical data of 313 patients with NVAF who were hospitalized in the Third Affiliated Hospital of Anhui Medical University from April 2020 to April 2023 were retrospectively analyzed.According to whether combination of AIS,the patients were divided into the stroke group(150 cases,patients with NVAF combined with AIS)and non-stroke group(163 cases,patients with NVAF alone).The differences in clinical data between the two groups were compared;logistic regression was used to analyze the correlation between Lp(a),RDW and NVAF patients combined with AIS;and the receiver operating characteristics(ROC)curve was plotted to evaluate the predictive value of Lp(a)and RDW for AIS.Results The average age history of hypertension,proportion of persistent atrial fibrillation and CHA2DS2-VASc score in the stroke group were higher than those in the non-stroke group,and the differences were statistically significant(P<0.05).Lp(a)and RDW in the stroke group were significantly higher both than those in the non-stroke group(P<0.05),and the results of multivariate logistic regression analysis showed that Lp(a)(OR=1.003,95%CI 1.002-1.005,P<0.01)and RDW(OR=1.913,95%CI 1.373-2.665,P<0.01)both were the independent risk factor for AIS in patients with NVAF.The ROC curve showed that the areas under the curve of Lp(a),RDW and Lp(a)combined with RDW were 0.685,0.695 and 0.755 in patients with NVAF,respectively.Conclusion Lp(a)and RDW both are the independent risk factors for AIS in patients with NVAF,and the test of combination of the two has certain predictive value forAIS in patients with NVAF.