血清脂蛋白相关磷脂酶A2对老年稳定性冠心病患者远期预后的预测价值

Predictive value of serum lipoprotein-associated phospholipase A2for long-term prognosis of elderly patients with stable CHD

目的探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)对老年稳定性冠心病患者远期预后的预测价值。方法回顾性收集2016年1月至2018年12月南通市第一人民医院收治的老年稳定性冠心病患者198例,对患者随访5年,根据患者5年内是否发生不良心血管事件,将患者分为不良心血管事件组42例和对照组156例,比较2组患者临床特征和Lp-PLA2差异,同时分析Lp-PLA2对老年稳定性冠心病患者5年内发生不良心血管事件的预测价值。结果与对照组比较,不良心血管事件组患者年龄[(74.95±7.02)岁vs(70.17±6.30)岁,P=0.000]、糖尿病(54.76%vs 27.56%,P=0.001)、冠状动脉狭窄≥75%(69.05%vs 47.44%,P=0.013)、左心室射血分数<50%(50.00%vs 28.21%,P=0.008)、Lp-PLA2[(478.38±187.54)U/L vs(308.17±126.73)U/L,P=0.000]显著增高。年龄和Lp-PLA2曲线下面积分别为0.683(95%CI:0.590~0.776,P<0.01)和0.763(95%CI:0.677~0.848,P=0.763)。多因素logistics回归分析显示,年龄、糖尿病、冠状动脉狭窄≥75%、左心室射血分数<50%和Lp-PLA2是老年稳定性冠心病患者5年内发生不良心血管事件的独立影响因素(P<0.05,P<0.01)。结论Lp-PLA2增高与稳定性冠心病患者5年内发生不良心血管事件相关。

Objective To investigate the predictive value of serum lipoprotein-associated phospholipase A2(Lp-PLA2)for long-term prognosis of elderly patients with stable coronary heart disease(CHD).Methods A retrospective trial was conducted on 198patients with stable CHD admitted to our hospital from January 2016to December 2018.All of them were followed up for 5 years,and divided into adverse cardiovascular event group(n=42)and control group(n=156)according to whether adverse cardiovascular events occurred during follow-up.Clinical features and Lp-PLA2level were compared between the two groups.The predictive value of Lp-PLA2for adverse cardiovascular events was analyzed in elderly patients with stable CHD within 5years.Results The adverse cardiovascular event group had significantly older age(74.95±7.02 vs 70.17±6.30years,P=0.000),larger proportions of diabetes(54.76%vs 27.56%,P=0.001),of coronary artery stenosis≥75%(69.05%vs 47.44%,P=0.013)and of left ventricular ejection fraction(LVEF)<50%(50.00%vs 28.21%,P=0.008),and higher Lp-PLA2level(478.38±187.54U/L vs 308.17±126.73U/L,P=0.000)when compared with the control group.The AUC value of age and Lp-PLA2was 0.683(95%CI:0.590-0.776,P<0.001)and 0.763(95%CI:0.677-0.848,P=0.763),respectively,in predicting the long-term prognosis in elderly patients with stable CHD.Multivariate logistic regression analysis showed that age,diabetes,coronary artery stenosis≥75%,LVEF<50%and Lp-PLA2were independent influencing factors for adverse cardiovascular events within 5years in elderly patients with stable CHD(P<0.05,P<0.01).Conclusion Increased Lp-PLA2level is associated with adverse cardiovascular events within 5years in patients with stable CHD.