糖脂代谢异常与慢性心力衰竭患者心功能分级及MACE发作风险的相关性

Correlation analysis of abnormal glycolipid metabolism with heart function classification and risk of major adverse cardiovascular events in patients with chronic heart failure

目的 探究糖脂代谢相关指标与慢性心力衰竭(心衰)患者心功能分级和主要心脏不良事件(MACE)发作的相关性。方法 选择2019年10月至2021年8月期间收治的220例慢性心衰患者作为研究对象。采用全自动生活分析仪测定总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、脂蛋白a(Lpa)水平;酶联免疫吸附法测定血清脂蛋白相关磷脂酶A_(2)(Lp-PLA_(2))水平。采集末梢静脉血测定患者的空腹血糖(FPG)、糖化血红蛋白(glycated hemoglobin A_(1C),HbA_(1C))水平。随访MACE发作情况。Spearman方分析TC、TG、LDL-C、HDL-C、Lpa、Lp-PLA_(2)、FPG、HbA_(1C)与患者心功能分级及MACE发作的相关性。结果 不同心功能分级患者HDL-C、Lpa、Lp-PLA_(2)、FPG以及HbA_(1C)水平差异有统计学意义(P<0.05,P<0.01)。MACE发作组患者的TG、LDL-C、Lpa、FPG以及HbA_(1C)明显高于MACE未发作组,HDL-C、Lp-PLA_(2)水平明显低于MACE未发作组,差异有统计学意义(P<0.01)。将MACE发作情况作为因变量(1=发作,0=未发作),经非条件logistic回归分析结果得出,TG、LDL-C、HDL-C、Lpa、Lp-PLA_(2)、FPG及HbA_(1C)均是影响MACE发作的危险因素(OR>1,P<0.05)。经Spearman相关分析发现,Lpa以及HbA_(1C)水平与慢性心衰患者心功能分级呈正相关(P<0.01),Lp-PLA_(2)与慢性心衰患者心功能分级呈负相关(P<0.01);慢性心衰患者MACE发作与Lpa以及HbA_(1C)水平呈正相关(P<0.01),与HDL-C和Lp-PLA_(2)呈负相关(P<0.05或P<0.01)。HDL-C、Lpa、Lp-PLA_(2)、HbA_(1C)预测MACE发作的AUC分别为0.754、0.866、0.902、0.873。结论 糖脂代谢指标HDL-C、Lpa、Lp-PLA_(2)、HbA_(1C)水平与慢性心衰患者的心功能分级和MACE发作具有相关性,将其作为评估慢性心衰患者预后情况的辅助指标具有一定的临床价值。

Objective To investigate the correlation between abnormal glycolipid metabolism and heart function classification as well as the risk of major adverse cardiovascular events(MACE)in patients with chronic heart failure(CHF).Methods A retrospective analysis was conducted on a cohort of 220 patients diagnosed with CHF between October 2019 and August 2021.Automated analyzers were used to measure the levels of total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),and lipoprotein(a)(Lpa).Enzyme-linked immunosorbent assays were utilized to determine the serum levels of lipoprotein-associated phospholipase A_(2)(Lp-PLA_(2)).Peripheral venous blood samples were collected to measure fasting plasma glucose(FPG)and glycated hemoglobin A_(1C)(HbA_(1C))levels.Follow-up assessments were conducted to monitor the occurrence of MACE.The Spearman rank correlation coefficient was employed to assess the correlation between TC,TG,LDL-C,HDL-C,Lpa,Lp-PLA_(2),FPG,HbA_(1C),heart function classification,and the occurrence of MACE.Results Significant differences in HDL-C,Lpa,Lp-PLA_(2),FPG,and HbA_(1C) levels were observed among patients with different heart function classifications(P<0.05 or P<0.01).Patients in the MACE group showed higher levels of TG,LDL-C,Lpa,FPG,and HbA_(1C),and lower levels of HDL-C and Lp-PLA_(2) as compared to those in the non-MACE group(P<0.01).Non-conditional logistic regression analysis revealed that TG,LDL-C,HDL-C,Lpa,Lp-PLA_(2),FPG,and HbA_(1C) were all risk factors for MACE(OR>1,P<0.05).Spearman correlation analysis indicated a positive correlation between Lpa and HbA_(1C) levels with heart function classification in patients with CHF(P<0.01),while Lp-PLA_(2) was negatively correlated with heart function classification(P<0.01).Moreover,a positive correlation was found between MACE occurrence with Lpa and HbAIc levels in patients with CHF(P<0.01),whereas a negative correlation was observed with HDL-C and Lp-PLA_(2) levels(P<0.05 or P<0.01).HDL-C,Lpa,Lp-PLA_(2),and HbA_(1C) demonstrated area under the curve(AUC)values of 0.754,0.866,0.902,and 0.873,respectively,in predicting MACE occurrence.Conclusion The levels of glycolipid metabolism indicators,including HDL-C,Lpa,Lp-PLA_(2),and HbA_(1C),are correlated with heart function classification and the occurrence of MACE in patients with CHF.These indicators can serve as auxiliary measures for assessing the prognosis of CHF patients in clinical practice.