脂蛋白相关磷脂酶A2与冠心病患者踝臂指数、心率变异性的相关性研究

背景踝臂指数(ABI)可预测冠状动脉狭窄,心率变异性(HRV)降低与冠心病(CHD)的进展有关,脂蛋白相关磷脂酶A2(Lp-PLA2)是CHD患者冠状动脉狭窄的危险因素,但三者之间的关系目前尚不明确。目的分析Lp-PLA2与CHD患者ABI、HRV的相关性,并分析Lp-PLA2对CHD患者ABI及HRV异常的预测价值。方法选取2016年4月-2019年1月汕头大学附属粤北人民医院心血管内科确诊的非CHD患者292例作为A组,同期确诊的CHD患者389例作为B组。比较两组患者一般资料、实验室检查指标、血脂指标及ABI、HRV;变量间的相关性分析采用Pearson偏相关及多元线性回归分析;绘制ROC曲线以评价Lp-PLA2对CHD患者ABI及HRV异常的预测价值。结果 (1)两组患者高血压病史、体质指数(BMI)、三酰甘油(TG)、载脂蛋白B (ApoB)比较,差异无统计学意义(P>0.05);B组患者年龄、有2型糖尿病病史者所占比例、同型半胱氨酸(Hcy)、Lp-PLA2、糖化血红蛋白(HbA1c)、超敏C反应蛋白(hs-CRP)、脂蛋白aLP (a)]高于A组,总胆固醇(TC)、载脂蛋白A (ApoA)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、ABI及全部窦性心搏RR间期的标准差(SDNN)低于A组(P<0.05)。(2) Lp-PLA2未进入多元线性回归方程。Pearson偏相关分析结果显示,ABI与CHD (r=-0.147)、Hcy (r=-0.082)呈负相关,与BMI (r=0.119)、SDNN (r=0.157)呈正相关(P<0.05)。多元线性回归分析结果显示,ABI与CHD (β=-0.50)和Hcy (β=-0.01)呈负相关,与BMI (β=0.004)和SDNN (β=0.001)呈正相关(P<0.05)。(3)Pearson偏相关分析结果显示,SDNN与Lp-PLA2 (r=-0.098)、hs-CRP (r=-0.123)呈负相关(P<0.05)。多元线性回归分析结果显示,SDNN与CHD患者LP-PLA2 (β=-0.040)、hs-CRP (β=-4.388)负相关,与ABI (β=43.301)呈正相关(P<0.05)。(4)ROC曲线显示,Lp-PLA2预测CHD患者ABI异常的曲线下面积(AUC)为0.58395%CI(0.480,0.687)],灵敏度为0.84、特异度为0.38;Lp-PLA2预测CHD患者SDNN异常的AUC为0.65695%CI(0.600,0.712)],灵敏度为0.76,特异度为0.48。结论 CHD患者Lp-PLA2升高,ABI、HRV降低;Lp-PLA2与CHD患者HRV呈负相关且对CHD患者HRV异常有一定的预测价值,但其与CHD患者ABI无关,而ABI与CHD患者HRV呈正相关。

Correlations of Lipoprotein-associated Phospholipase A2 with Ankle-brachial Index and Heart Rate Variability in Patients with Coronary Heart Disease

Background Ankle-brachial index(ABI)can predict coronary artery stenosis,decrease of heart rate variability(HRV)is associated with progress of coronary heart disease(CHD),lipoprotein-associated phospholipase A2(Lp-PLA2)is the risk factor of coronary artery stenosis in patients with CHD,however,interrelationship of the above three is not yet clear. Objective To analyze the correlations of Lp-PLA2 with ABI and HRV in patients with CHD,and to analyze the predictive value of Lp-PLA2 on ABI abnormity as well as HRV abnormity in patients with CHD. Methods From April 2016 to January 2019,292 non-CHD patients were selected as A group in the Department of Cardiovascular Medicine,North Guangdong People’s Hospital Affiliated to Shantou University,meanwhile 389 patients with CHD were selected as B group. Comparison of general information,laboratory examination results,blood lipid parameters,ABI and HRV was conducted between the two groups;Pearson partial correlation analysis and multiple linear regression analysis were used to analyze the correlations between variables,moreover ROC curve was drawn to evaluate the predictive value of Lp-PLA2 on ABI abnormity as well as HRV abnormity in patients with CHD. Results(1)No statistically significant difference of history of hypertension,BMI,TG or ApoB was found between the two groups(P>0.05);age,proportion of patients with history of diabetes,Hcy,Lp-PLA2,HbA1 c,hs-CRP and Lp(a)in B group were statistically significantly higher than those in A group,while TC,ApoA,HDL-C,LDL-C,ABI and SDNN in B group were statistically significantly lower than those in A group(P<0.05).(2)Lp-PLA2 did not enter into the multiple linear regression analysis. Pearson partial correlation analysis results showed that,ABI was negatively correlated with CHD(r=-0.147)and Hcy(r=-0.082),respectively,but was positively correlated with BMI(r=0.119)and SDNN(r=0.157),respectively(P<0.05). Multiple linear regression analysis results showed that,ABI was negatively correlated with CHD(β=-0.50)and Hcy(β=-0.01),respectively,but was positively correlated with BMI(β=0.004) and SDNN(β=0.001),respectively(P<0.05).(3)Pearson partial correlation analysis results showed that,SDNN was negatively correlated with Lp-PLA2(r=-0.098)and hs-CRP(r=-0.123),respectively(P<0.05). Multiple linear regression analysis results showed that,SDNN was negatively correlated with LP-PLA2(β=-0.040) and hs-CRP(β=-4.388),respectively,but was positively correlated with ABI(β=43.301)(P<0.05).(4) ROC curves indicated that,AUC,sensitivity and specificity of Lp-PLA2 in predicting ABI abnormity in patients with CHD was 0.583 95%CI(0.480,0.687)],0.84 and 0.38,respectively;AUC,sensitivity and specificity of Lp-PLA2 in predicting SDNN abnormity in patients with CHD was 0.65695%CI(0.600,0.712)],0.76 and 0.48,respectively. Conclusion Lp-PLA2 increases but ABI and HRV decrease in patients with CHD;Lp-PLA2 is negatively correlated with HRV and it has predictive value on HRV abnormity in patients with CHD to some extent,however Lp-PLA2 is not significantly correlated with ABI in patients with CHD,but there is positive correlation between ABI and HRV.