脂蛋白(a)与急性ST段抬高型心肌梗死预后的相关性研究

Study on the Correlation between Lipoprotein (a) and the Prognosis of Acute ST-Segment Elevation Myocardial Infarction

摘要: 目的：分析脂蛋白(a) [Lp (a)]与急性ST段抬高型心肌梗死(STEMI)预后的相关性，为临床提供相关的STEMI预后的参考指标。方法：选取2018年10月~2020年5月在我院急诊病房住院就诊的STEMI患者460例，血清Lp (a)以四分位法分A组(<4.5 mg/dl，120例)，B组(4.5~12.6 mg/dl，112例)，C组(12.7~28.5 mg/dl，116例)，D组(>28.6 mg/dl，112例)。分析4组患者的Lp (a)水平与患者的一般资料、MACCE的单因素与多因素COX回归关系以及特异性、敏感度的情况。结果：随着血清Lp (a)水平上升，空腹血糖水平、HDL-C水平明显较A组降低(P < 0.05)，年龄、脑卒中病史比例、Apo B水平、LVEF < 40%比例明显大于A组(P < 0.05)；四组患者的性别、BMI、吸烟史、高血压病史、糖尿病病病史、血脂异常、心肌梗死病史、PCI史、肌酐、TG、TC、LDL-C、Apo A的临床指标比较，差异均无统计学意义(P > 0.05)。四组患者在PCI术后2年MACCE发生率分别为9.17%、14.28%、13.79%、25.00%，且情况有统计学意义(P < 0.05)，D组MACCE发生率明显高于A组、B组、C组(P均 < 0.05)，但A组、B组、C组两两比较，无统计学意义(P > 0.05)。对单变量分析将P < 0.15或P值 > 0.15，但临床上认为与因变量关系密切的自变量进行多因素COX分析，LVEF < 40%水平是STEMI患者MACCE发生的保护因素，年龄、Lp (a)、冠脉多支病变和脑中风史是独立危险因素。远期MACCE发生率随Lp (a)水平每增加1 mg/dL而提高0.015倍。根据ROC曲线确定Lp (a)的临界值为28.50 mg/dL，Lp (a)预测行直接PCI的STEMI患者术后2年MACCE发生率的特异性为76.78%，敏感度为42.85%。结论：血清Lp (a)水平是直接PCI术后STEMI患者预后MACCE发生的独立危险因素，且随Lp (a)水平增加，累积远期MACCE发生率明显上升。

Abstract: Objective: To analyze the correlation between lipoprotein (a) [Lp (a)] and the prognosis of acute ST-segment elevation myocardial infarction (STEMI), to provide clinical reference indicators for the prognosis of STEMI. Methods: From January 2019 to October 2020, 460 STEMI patients who were admitted to the CCU ward of our hospital were selected. Serum Lp (a) was divided into group A (<4.5 mg/dl, 120 cases) and group B by quartile. (4.5 - 12.6 mg/dl, 112 cases), group C (12.7 - 28.5 mg/dl, 116 cases), group D (>28.6 mg/dl, 112 cases). Analyze the Lp (a) level of the 4 groups of patients and the general data of the patients, the regression relationship between the univariate and multivariate COX of MACCE, and the specificity and sensitivity. Results: With the increase of serum Lp (a) levels, fasting blood glucose levels and HDL-C levels were significantly lower than those of group A (P < 0.05), and the proportion of age, stroke history, Apo B levels, and LVEF < 40% were significantly greater than those of group A (P < 0.05); comparison of clinical indicators of gender, BMI, smoking history, hypertension, diabetes, dyslipidemia, myocardial infarction, PCI, creatinine, TG, TC, LDL-C, and Apo A in the four groups, the difference was not statistically significant (P > 0.05). The incidence of MACCE in the four groups of patients at 2 years after PCI was 9.17%, 14.28%, 13.79%, 25.00%, and the situation was statistically significant (P < 0.05). The incidence of MACCE in group D was significantly higher than that in group A and group B. Groups and C groups (all P < 0.05), but there was no statistically significant comparison between groups A, B and C (P > 0.05). For univariate analysis, P < 0.15 or P value > 0.15, but independent variables that are clinically believed to be closely related to the dependent variable are subjected to multivariate COX analysis. LVEF < 40% is a protective factor for MACCE in STEMI patients. Age, Lp (a) multivessel disease of coronary artery and history of stroke are independent risk factors. The incidence of long-term MACCE increased 0.015 times with every 1 mg/dL increase in Lp (a) level. According to the ROC curve, the cut-off value of Lp (a) was 28.50 mg/dL. The specificity of Lp (a) for predicting the incidence of MACCE in STEMI patients undergoing direct PCI at 2 years after surgery was 76.78% and the sensitivity was 42.85%. Conclusion: Serum Lp (a) level is an independent risk factor for the prognosis of MACCE in STEMI patients after direct PCI. With the increase of Lp (a) level, the cumulative long-term MACCE rate increases significantly.