联合检测同型半胱氨酸与脂蛋白a对高血压患者动脉粥样硬化的预测意义

Combined homocysteine and lipoprotein(a)for predicting atherosclerosis in hypertensive patients

目的:探讨联合检测高血压患者同型半胱氨酸(Hcy)、脂蛋白a[Lp(a)]对动脉粥样硬化(AS)风险的预测价值。方法:分别采用酶循环法和免疫比浊法检测326例高血压AS患者(AS组)和324例高血压非AS患者(非AS组)血清中Hcy、Lp(a)水平,采用二元logistic回归分析高血压患者AS的影响因素。通过受试者工作特征曲线(ROC曲线)分析血清Hcy和Lp(a)联合检测对AS风险的预测价值。结果:AS组血浆Hcy、Lp(a)、低密度脂蛋白胆固醇(LDL-C)水平明显高于非AS组(P均<0.05)。Logistic回归分析显示,血浆Hcy、Lp(a)、LDL-C是AS的影响因素(P均<0.05);ROC曲线分析提示,Hcy检测的曲线下面积(AUC)为0.829,95%CI:0.797~0.861,敏感度76.5%,特异性84.6%(P<0.001);Lp(a)检测的AUC为0.841,95%CI:0.807~0.876,敏感度77.2%,特异性81.3%(P<0.001);Hcy与Lp(a)联合检测的AUC为0.942,95%CI:0.926~0.958,敏感度83.8%,特异性85.2%(P<0.001)。结论:Hcy与Lp(a)联合检测可提高对高血压患者早期AS风险的预测效能。

Objective To investigate the performance of combined homocysteine(Hcy)and lipoprotein(a)[Lp(a)]for assessing atherosclerosis(AS)risk in hypertensive patients.Methods Serum levels of Hcy and Lp(a)were measured by enzyme cycling and immunoturbidimetric assays in 650 hypertensive patients with(AS group,n=326)or without AS(non-AS group,n=324).Binary logistic regression was performed to analyze the influencing factors of AS in hypertensive patients.The predictive value of combined Hcy and Lp(a)levels for presence of AS was evaluated by Receiver-operating characteristic(ROC)curve analysis.Results Serum levels of Hcy,Lp(a),and low-density lipoprotein cholesterol(LDL-C)were significantly higher in AS group than in non-AS group(all P<0.05).Serum Hcy,Lp(a),and LDL-C were closely associated with AS(all P<0.05).In terms of predictive value of Hcy,Lp(a)or both for the presence of AS,ROC analysis showed that area under the curve(AUC)for Hcy was 0.829(95%CI:0.797-0.861),sensitivity 76.5%,specificity 84.6%(P<0.001),AUC for Lp(a)was 0.841(95%CI:0.807-0.876),sensitivity 77.2%,specificity 81.3%(P<0.001),and AUC for combined Hcy and Lp(a)was 0.942(95%CI:0.926-0.958),sensitivity 83.8%.specificity 85.2%(P<0.001).Conclusion Combined serum Hcy and Lp(a)levels improve the predictive efficacy of early AS risk in hypertensive patients.