心力衰竭患者中Lp(a)、HDL-C和ApoA1的联合检测对预后的预测价值

Predictive value of combined detection of Lp(a),HDL-C,and ApoA1 in patients with heart failure for prognosis

目的:探究脂蛋白(a)[Lp(a)]、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A(ApoA)联合预测心力衰竭患者预后的价值。方法:选取2020年1月至2022年1月在本院就诊的160例心力衰竭患者为研究组,另选取同期于本院体检的40例健康人群为对照组,比较两组Lp(a)、HDL-C、ApoA水平。随访1 y,依据是否发生主要不良心血管事件(MACE)将研究组患者分为预后良好组与预后不良组,比较不同预后心力衰竭患者临床指标、Lp(a)、HDL-C、ApoA水平的差异;Logistic回归分析心力衰竭患者预后不良的影响因素;绘制ROC曲线分析上述指标对心力衰竭患者预后的预测价值。结果:研究组患者的Lp(a)水平高于对照组,但其HDL-C、ApoA水平均较对照组更低(P<0.05)。在Lp(a)水平比较上,NYHA分级Ⅱ级<Ⅲ级<Ⅳ级(P<0.05);在HDL-C、ApoA水平比较上,NYHA分级Ⅱ级>Ⅲ级>Ⅳ级(P<0.05)。160例心力衰竭患者,1 y随访,预后良好120例,预后不良40例,NYHA分级Ⅳ级、Lp(a)、HDL-C、ApoA均为心力衰竭患者预后不良的危险因素(P<0.05)。Lp(a)、HDL-C、ApoA诊断心力衰竭患者预后不良的AUC为0.843(95%CI为0.777-0.896)、0.784(95%CI为0.712-0.845)、0.783(95%CI为0.710-0.844);三者联合诊断心力衰竭患者预后不良的AUC为0.913(95%CI为0.858-0.952),均较各单一指标诊断效能更高(Z=3.087、3.619、3.233,P<0.05)。结论:心力衰竭患者血清Lp(a)异常升高,HDL-C、ApoA异常降低,三者联合检测对心力衰竭患者预后具有较高的评估预测价值。

Objective:To explore the value of combining lipoprotein(a)[Lp(a)],high-density lipoprotein cholesterol(HDL�C),and apolipoprotein A(ApoA)in predicting the prognosis of heart failure patients.Methods:160 patients with heart failure who visited our hospital from January 2020 to January 2022 were selected as the study group,and 40 healthy individuals who underwent physical examinations at our hospital during the same period were selected as the control group.The levels of Lp(a),HDL-C,and ApoA were compared between the two groups.Follow up patients for a period of one year,and divide the study group into a good prognosis group and a poor prognosis group based on whether major adverse cardiovascular events(MACE)have occurred.Compare the differences in clinical indicators,Lp(a),HDL-C,and ApoA levels among heart failure patients with different prognoses;Logistic regression analysis of factors influencing poor prognosis in patients with heart failure;Draw ROC curves to analyze the predictive value of the above indicators for the prognosis of heart failure patients.Results:The Lp(a)levels of patients in the study group were higher than those in the control group,but their HDL-C and ApoA levels were lower than those in the control group(P<0.05).At the level of Lp(a),the NYHA classification is level II<level III<level IV(P<0.05);In comparison of HDL-C and ApoA levels,the NYHA classification is level II>level III>level IV(P<0.05).In this study,160 patients with heart failure were followed up for 1 year.Among them,120 had a good prognosis and 40 had a poor prognosis.NYHA grade IV,Lp(a),HDL-C,and ApoA were all risk factors for poor prognosis in heart failure patients(P<0.05).The AUC for diagnosing poor prognosis in heart failure patients with Lp(a)is 0.843(95%CI,0.777-0.896);The AUC with poor prognosis in HDL-C diagnosis of heart failure patients is 0.784(95%CI,0.712-0.845);The AUC for poor prognosis in patients with heart failure diagnosed by ApoA is 0.783(95%CI,0.710-0.844);The AUC of poor prognosis in patients with heart failure diagnosed by the combination of the three indicators was 0.913(95%CI,0.858-0.952),which was higher than the diagnostic efficacy of various single indicators(Z=3.087,3.619,3.233,P<0.05).Conclusion:The serum Lp(a)in patients with heart failure is abnormally elevated,while HDL-C and ApoA are abnormally reduced.The combined detection of the three has high predictive value for the prognosis of heart failure patients.