血脂蛋白a联合MHR对NSTE-ACS患者冠状动脉病变严重程度及预后的评估价值

目的探讨脂蛋白aLp(a)]联合单核细胞/高密度脂蛋白胆固醇(HDL-C)比值(MHR)在非ST段抬高型急性冠脉综合征(NSTE-ACS)患者冠状动脉(冠脉)病变严重程度及预后中的评估及其价值。方法选择2020年3月至2021年3月安徽医科大学第一附属医院符合纳入标准的NSTE-ACS患者(n=310),依据冠脉造影结果进行Gensini评分,以Gensini积分的第3四分位数(Q_U=38)为切点,分为高危组(Q_U≥38,n=74)和非高危组(Q_U<38,n=236),比较其一般资料,并使用Logistic回归分析Lp(a)、MHR与冠脉病变严重程度的相关性;使用ROC曲线评估Lp(a)联合MHR评估冠脉病变严重程度及预后的价值。结果高危组和非高危组患者性别、吸烟史、高血压病、糖尿病、高胆固醇血症、肾功能不全等病史、他汀药物应用发生率差异无统计学意义(P>0.05),但高危组患者年龄、血Lp(a)水平和MHR均显著高于非高危组(P<0.01)。Spearman相关分析发现,Lp(a)和MHR分别与Gensini评分呈正相关(r=0.316,P<0.05;r=0.715,P<0.05)。Logistic多因素二元回归分析示,Lp(a)、年龄和MHR是冠脉高危病变的独立危险因素(P<0.01,P<0.05)。ROC曲线分析示,Lp(a)和MHR联合检测对冠脉高危病变评估的AUC(0.854),分别大于Lp(a)和MHR单独检测的AUC(0.852、0.754);联合评估的敏感度73.0%,高于单独检测Lp(a)的55.6%,但低于MHR的82.4%;联合评估的特异度85.6%,高于Lp(a)及MHR单独检测(84.1%、61.9%)。ROC曲线分析示,Lp(a)和MHR联合对NSTE-ACS患者不良预后评估的AUC(0.800),分别大于Lp(a)和MHR单独检测的AUC(0.781、0.739);联合评估患者预后的敏感度为72.2%,高于Lp(a)及MHR单独检测(66.7%、66.7%);联合评估的特异度为81.9%,高于MHR单独检测的80.9%,但低于Lp(a)单独检测的84.8%。结论异常升高的血Lp(a)水平联合MHR对NSTE-ACS患者冠脉病变的严重程度和不良预后具有较高的判断价值。

Predictive value of lipoprotein a combined with MHR for severity and prognosis of coronary artery lesions in NSTE-ACS patients

Objective To explore the predictive value of lipoprotein aLp(a)]combined with monocyte to high-density lipoprotein cholesterol ratio(MHR)for coronary artery lesions severity and prognosis in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods A total of 310 NSTE-ACS patients admitted to the First Affiliated Hospital of Anhui Medical University from March 2020 to March 2021 were enrolled.Taking the third quartile of Gensini score(Q_u=38)as the cut-off point according to coronary angiography,the patients were divided into high-risk(Q_u≥38,n=74)group and non high-risk(Q_u<38,n=236)group.Logistic regression was used to analyze the associations of Lp(a)and MHR with the severity of coronary artery lesions,and ROC curve was used to evaluate the value of Lp(a)combined with MHR in determining the severity and prognosis of coronary artery lesions.Results There were no significant differences in general clinical data between two groups,including gender,smoking history,incidences of hypertension,diabetes,hypercholesterolemia,renal insufficiency and statins using(P>0.05),however,the age,blood Lp(a)level and MHR in high-risk group were significantly higher than those in non high-risk group(P<0.01).Spearman correlation analysis found that Lp(a)and MHR were positively correlated with Gensini scores,respectively(r=0.316,P<0.05;r=0.715,P<0.05).Multivariate binary Logistic regression analysis showed that the Lp(a)level,age and MHR were independent risk factors for coronary high-risk lesions(P<0.01,P<0.05).In evaluating high-risk coronary lesions,ROC curve analysis showed that AUC of Lp(a)with MHR(0.854)was greater than those of Lp(a)and MHR alone(0.852,0.754),respectively.The sensitivity of joint evaluationLp(a)and MHR]was 73.0%and was higher than 55.6%of Lp(a)alone,but it was lower than 82.4%of MHR.The specificity of joint evaluation was 85.6%and was respectively higher than that of Lp(a)and MHR alone(84.1%,61.9%).In evaluating poor prognosis of NSTE-ACS patients,ROC curve analysis showed that AUC of the combined detection of Lp(a)and MHR was 0.800 and was respectively greater than that of Lp(a)(0.781)and MHR(0.739).The sensitivity of Lp(a)combined with MHR was 72.2%and was higher than 66.7%of Lp(a)and 66.7%of MHR alone.The specificity of combined detection of Lp(a)and MHR was 81.9%and was higher than 80.9%of MHR,but was lower than 84.8%of Lp(a).Conclusion Abnormally elevated blood Lp(a)level combined with MHR has a high value in judging the severity of coronary artery lesions and poor prognosis in patients with NSTE-ACS.