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
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摘要
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.
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.
引文
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13.Sharma A,Stevens SR,Lucas J,et al.Utility of growth differentiation factor-15,a marker of oxidative stress and inflammation,in chronic heart failure:insights from the HF-ACTION study[J].JACC Heart Fail,2017,5(10):724-734.
14.Yang L,Wang H,Zhang Y,et al.The prognostic value of lipoproteinassociated phospholipase A2 in the long-term care of patients with acute coronar y syndrome undergoing percutaneous coronar y intervention[J].Clin Appl Thromb Hemost,2018,24(5):822-827.
2.Li D,Wei W,Ran X,et al.Lipoprotein-associated phospholipase A2and risks of coronary heart disease and ischemic stroke in the genera population:A systematic review and meta-analysis[J].Clin Chim Acta2017,471:38-45.
3.Garg PK,Mcclelland RL,Jenny NS,et al.Lipoprotein-associated phospholipase A2 and risk of incident cardiovascular disease in a multi-ethnic cohort:The multi ethnic study of atherosclerosis[J]Atherosclerosis,2015,241(1):176-182.
4.Tian Y,Jia H,Li S,et al.The associations of stroke,transient ischemic attack,and/or stroke-related recurrent vascular events with Lipoprotein-associated phospholipase A2:A systematic review and meta-analysis[J].Medicine(Baltimore),2017,96(51):e9413.
5.Li J,Wang H,Tian J,et al.Change in lipoprotein-associated phospholipase A2 and its association with cardiovascular outcomes in patients with acute coronary syndrome[J].Medicine(Baltimore)2018,97(28):e11517.
6.Li N,Li S,Yu C,et al.Plasma Lp-PLA2 in acute coronary syndrome association with major adverse cardiac events in a community-based cohort[J].Postgrad Med,2010,122(4):200-205.
7.Suzuki T,Solomon C,Jenny NS,et al.Lipoprotein-associated phospholipase A(2)and risk of congestive heart failure in older adults the Cardiovascular Health Study[J].Circ Heart Fail,2009,2(5):429-436
8.Van Vark LC,Kardys I,Bleumink GS,et al.Lipoprotein-associated phospholipase A2 activity and risk of heart failure:The Rotterdam study[J].Eur Heart J,2006,27(19):2346-2352.
9.Cerlinskaite K,Javanainen T,Cinotti R,et al.Acute heart failure management[J].Korean Circ J,2018,48(6):463-480.
10.Correale M,Monaco I,Brunetti ND,et al.Redefining biomarkers in heart failure[J].Heart Fail Rev,2018,23(2):237-253.
11.Chang KW,Fox S,Mojaver S,et al.Using biomarkers to guide heart failure management[J].Expert Rev Cardiovasc Ther,2017,15(10)729-741.
12.Richards AM.N-terminal B-type natriuretic peptide in heart failure[J]Heart Fail Clin,2018,14(1):27-39.
13.Sharma A,Stevens SR,Lucas J,et al.Utility of growth differentiation factor-15,a marker of oxidative stress and inflammation,in chronic heart failure:insights from the HF-ACTION study[J].JACC Heart Fail,2017,5(10):724-734.
14.Yang L,Wang H,Zhang Y,et al.The prognostic value of lipoproteinassociated phospholipase A2 in the long-term care of patients with acute coronar y syndrome undergoing percutaneous coronar y intervention[J].Clin Appl Thromb Hemost,2018,24(5):822-827.