Lp(a)、ApoB及Apelin-13与老年冠心病患者颈动脉粥样硬化斑块的相关性

Correlation of Lp(a),ApoB and Apelin-13 with carotid atherosclerotic plaques in elderly patients with coronary heart disease

目的探讨脂蛋白a[Lp(a)]、载脂蛋白B(ApoB)及血管紧张素Ⅱ受体样1受体内源性配体13(Apelin-13)与老年冠心病(CHD)患者颈动脉粥样硬化(CAS)斑块的相关性。方法选取2020年4月—2022年4月邢台市第三医院收治的118例老年CHD患者为研究对象,所有患者入院后行颈动脉彩超检查,根据颈动脉内膜-中层厚度(IMT)将患者分为斑块组(87例)和非斑块组(31例)。收集患者一般资料,比较2组患者血清Lp(a)、ApoB及Apelin-13水平;采用逐步回归分析CHD患者CAS斑块发生的影响因素。根据半定量法将斑块组患者分为Ⅰ级(24例)、Ⅱ级(49例)和Ⅲ级(14例),比较不同斑块严重程度患者血清Lp(a)、ApoB及Apelin-13水平,分析血清Lp(a)、ApoB及Apelin-13与CAS斑块分级之间的关系。结果2组患者的性别构成、体质量指数(BMI)、CHD病程、美国纽约心脏病学会(NYHA)分级、患高血压比例、患高脂血症比例、饮酒比例、文化程度比较,差异均无统计学意义(P>0.05);斑块组患者年龄大于非斑块组,合并糖尿病和吸烟的比例高于非斑块组,差异均有统计学意义(P<0.05)。斑块组患者血清Lp(a)、ApoB水平高于非斑块组,Apelin-13水平低于非斑块组,差异均有统计学意义(P<0.05)。逐步回归分析结果显示,糖尿病、Lp(a)、ApoB是CHD患者CAS斑块发生的危险因素(P<0.05),Apelin-13是CHD患者CAS斑块发生的保护因素(P<0.05)。不同斑块严重程度患者血清Lp(a)、ApoB水平从高到低依次为Ⅲ级、Ⅱ级、Ⅰ级,血清Apelin-13水平从高到低依次为Ⅰ级、Ⅱ级、Ⅲ级;不同斑块严重程度患者血清Lp(a)、ApoB、Apelin-13水平比较,差异均有统计学意义(F=20.892、27.082、21.705,均P<0.001);相关性分析结果显示,CHD患者血清Lp(a)、ApoB与CAS斑块分级呈正相关(r_(s)=0.453、0.617,均P<0.001),Apelin-13与CAS斑块分级呈负相关(r_(s)=-0.467,P<0.001)。结论血清Lp(a)、ApoB及Apelin-13表达水平与老年CHD患者CAS斑块形成及斑块严重程度密切相关,临床应重点关注血清Lp(a)、ApoB、Apelin-13表达异常的老年CHD患者,及早干预治疗,以延缓CAS斑块的形成。

Objective To investigate the correlation of lipoprotein a[Lp(a)],apolipoprotein B(ApoB),and angiotensinⅡreceptor-like 1 receptor endogenous ligand 13(Apelin-13)with carotid atherosclerosis(CAS)plaques in elderly patients with coronary heart disease(CHD).Methods From April 2020 to April 2022,118 elderly patients with CHD were enrolled in the Third Hospital of Xingtai city.All patients received carotid artery color Doppler ultrasonography after admission.They were allocated to the plaque group(n=87)and the non-plaque group(n=31)following carotid intima-media thickness(IMT).The serum levels of Lp(a),ApoB,and Apelin-13 were compared between the two groups,and the influencing factors of CAS plaque in CHD patients were analyzed by stepwise regression.The patients in the plaque group were divided into grade Ⅰ(n=24),grade Ⅱ(n=49),and grade Ⅲ(n=14).The serum levels of Lp(a),ApoB,and apelin-13 in patients with different plaque severity were compared,and the association of serum Lp(a),ApoB,and apelin-13 with CAS plaque grade was analyzed.Results No significant difference was observed in gender composition,body mass index(BMI),duration of CHD,New York Heart Association(NYHA)classification,proportion of hypertension,proportion of hyperlipidemia,proportion of alcohol consumption,and education level between the two groups(P>0.05).Patients in the plaque group were older than those in the non-plaque group,and the proportion of diabetes and smoking was higher than that in the non-plaque group,with statistical significance(P<0.05).Serum Lp(a)and ApoB levels were higher and apelin-13 levels were significantly lower in the plaque group than in the non-plaque group(P<0.05).The results of stepwise regression analysis showed that diabetes mellitus,Lp(a),and ApoB were risk factors for CAS plaque in CHD patients(P<0.05);apelin-13 was a protective factor for CAS plaque in CHD patients(P<0.05).Serum Lp(a)and ApoB levels in patients with different plaque severity were grade Ⅲ,Ⅱ,and Ⅰ from high to low,and serum apelin-13 levels were grade Ⅰ,Ⅱ,and Ⅲ from high to low.Moreover,significant differences were found in serum Lp(a),ApoB,and apelin-13 levels between patients with different plaque severity(F=20.892,27.082,and 21.705,respectively;all P<0.001).Correlation analysis results showed that serum Lp(a)and ApoB were positively correlated with CAS plaque grade in CHD patients(r_(s)=0.453 and 0.617,all P<0.001),and apelin-13 was negatively correlated with CAS plaque grade(r_(s)=-0.467,P<0.001).Conclusion The expression levels of serum Lp(a),ApoB,and apelin-13 are closely correlated with CAS plaque formation and plaque severity in elderly patients with CHD.Attention should be paid to elderly patients with CHD who have abnormal expression of serum Lp(a),ApoB,and apelin-13 to delay the formation of CAS plaques.