ST段压低型患者血清Lp(a)及apoB/apoA-1与冠脉狭窄程度的相关性

Correlation between serum Lp(a)and apoB/apoA-1 and coronary stenosis inpatients with ST-segment depression

目的探讨Lp(a)、apoB/apoA-1对ST段压低型患者冠脉病变严重程度的预测价值。方法回顾性分析2020年1月至2023年6月于武汉市第四医院心血管内科住院并接受冠状动脉造影检查,筛选合并心电图ST段压低患者共163名。同期选取70例非冠心病患者且心电图无异常作为对照组。根据冠状动脉造影结果,将实验组分成轻、中、重度三组,比较三组的临床资料。采用二元多因素logistics回归分析中重度患者的独立危险因素。绘制受试者工作特征(ROC)曲线分析Lp(a)、apoB/apoA-1比值对中重度患者的诊断价值。结果(1)实验组与对照组之间年龄、高血压史、Lp(a)、UA、apoB、apoA-1、apoB/apoA-1比值、LDL-C、TG差异均有统计学意义(P<0.05)。(2)对于符合正态分布且同时满足方差齐性组间采用单因素方差分析,反之采用非参数检验,结果发现不同组的年龄、糖尿病史、Lp(a)、apoB、apoA-1、apoB/apoA-1比值、TC、TG水平差异具有统计学意义。其中Lp(a)、ApoB/ApoA-1比值二者均呈现出轻度狭窄<中度狭窄<重度狭窄。(3)将ST段压低型患者分为轻度狭窄、中重度狭窄组,运用二元多因素logistics回归分析两组间的差异,结果发现Lp(a)、apoB/apoA-1是影响中重度狭窄患者的冠脉病变程度的独立影响因素。(4)ROC曲线分析,Lp(a)、apoB/apoA-1在诊断ST压低型患者中重度狭窄病变时具有很高的价值,Lp(a)、apoB/apoA-1的AUC分别为0.818、0.862,敏感度为0.670、0.825,特异度为0.879、0.758(P<0.001),约登指数最大时分别对应的数值为24.50、0.785。结论Lp(a)、apoB/apoA-1对ST段压低型患者的冠脉病变具有一定的诊断和预测价值,为临床诊断冠状动脉粥样硬化提供一种简便、经济、全新的诊疗策略。

Objective To investigate the predictive value of Lp(a)and apoB/apoA-1 in the severity of coronary artery lesions inpatients with ST-segment depression.Methods A retrospective analysis was performed for 163 patients combined with ST-segment depression with electrocardiogram(ECG)from January 2020 to June 2023 who were hospitalized in the Department of Cardiovascular Medicine of Wuhanthe 4th Hospital and underwent coronary angiography.During the same period,70 patients with non-coronary heart disease and no abnormal ECG were selected as the control group.According to the results of coronary angiography,the experimental group was divided into three groups:mild,moderate and severe,and the clinical data of the three groups were compared.Binary multivariate logistics regression analysis was used to analyze the independent risk factors of patients with moderate to severe disease.The receiver operating characteristic(ROC)curve was plotted to analyze the diagnostic value of Lp(a)and apoB/apoA-1 ratios inpatients with moderate to severe disease.Results(1)There were statistically significant differences in age,history of hypertension,Lp(a),UA,apoB,apoA-1,ratio,LDL-C,TG between the experimental group and the control group(P<0.05).(2)One-way ANOVA was used for the normal distribution and the homogeneity of the variance was used for the group,and the non-parametric test was used for the non-parametric test,and the results showed that there were statistically significant differences in age,diabetes history,Lp(a),apoB,apoA-1,apoB/apoA-1 ratio,TC and TG levels among different groups.Among them,the Lp(a)and ApoB/ApoA-1 ratios showed mild stenosis<moderate stenosis<severe stenosis.(3)The patients with ST-segment depression were divided into mild stenosis and moderate to severe stenosis groups,and the differences between the two groups were analyzed by binary multivariate logistics regression,and the results showed that Lp(a)and apoB/apoA-1 were independent influencing factors affecting the degree of coronary art.(4)ROC curve analysis showed that Lp(a)and apoB/apoA-1 had high value in the diagnosis of moderate to severe stenosis lesions inpatients with ST depression,with the AUC of Lp(a)and apoB/apoA-1 being 0.818 and 0.862,the sensitivity being 0.670 and 0.825,the specificity being 0.879 and 0.758(P<0.001),and the corresponding values of Youden index being 24.50 and 0.785,respectively.Conclusion Lp(a)and apoB/apoA-1 have certain diagnostic and predictive value for coronary artery lesions inpatients with ST-segment depression,and provide a simple,economical and new diagnosis and treatment strategy for the clinical diagnosis of coronary atherosclerosis.