脂蛋白相关磷脂酶A2对慢性心功能不全患者预后的评估价值

Prognostic value of lipoprotein-associated phospholipase A2 in the prognosis of chronic heart failure

目的:研究脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)与慢性心功能不全患者预后的关系。方法:回顾性分析2016年11月至2017年8月滁州市第一人民医院慢性心功能不全患者的病例资料,从中提取出患者就诊时的Lp-PLA2和其他临床特征。通过电话随访患者。采用受试者工作特征(receiver operation curve,ROC)曲线、Kaplan-Meier法和Cox风险比例模型分析Lp-PLA2与患者1年内死亡之间的关系。结果:共有150名慢性心功能不全患者进入研究,其中47例在1年内死亡。慢性心功能不全患者的Lp-PL A2水平随着NYHA分期的增高而逐渐增高。1年内死亡的慢性心功能不全患者Lp-PLA2水平显著高于1年内存活的患者。Lp-PLA2预测患者1年内死亡的ROC曲线下面积为0.75。在校正年龄、性别、NHYA分期、肌酐、高血压病史和N末端-B型利钠尿肽的Cox风险比例模型中,Lp-PLA2仍然与患者的预后独立相关。Lp-PLA2每增加20 ng/mL,患者的死亡风险比为1.14。结论:Lp-PLA2是慢性心功能不全患者的独立预后因子。

Objective:To investigate the relationship between lipoprotein-associated phospholipase A2(Lp-PLA2)and prognosis of chronic heart failure.Methods:The medical records of chronic heart failure patients admitted to the First People’s Hospital of Chuzhou between November 2016 and August 2017 were retrospectively reviewed.Their Lp-PLA2 levels on admission were extracted.Subjects were followed up by telephone.The relationship between Lp-PLA2 and 1-year mortality of chronic heart failure was estimated by receiver operating characteristic(ROC)curve analysis,Kaplan-Meier curve and Cox model.Results:A total of 150 chronic heart failure patients were included in present study,and 47 of them died within 1 year after admission.Lp-PLA2 was significantly increased as the advance of NYHA grade.Subjects who died within 1 year had significantly higher Lp-PLA2 than those who was alive.The area under ROC curve of Lp-PLA2 for 1-year mortality was 0.74.After adjustment of age,gender,NYHA grade,creatine,hypertension and N-terminal pro B-type natriuretic peptide,Lp-PLA2 was independently associated with the prognosis of chronic heart failure,with a hazard ratio of 1.14 per 20 ng/mL.Conclusion:Lp-PLA2 is an independent prognostic factor for chronic heart failure.