血清脂蛋白(a)水平与新发ST段抬高型心肌梗死患者高血栓负荷的相关性及其预测作用

Correlation between serum lipoprotein(a) levels and high thrombus burden in patients with new-onset ST-segment elevation myocardial infarction and its predictive value

摘要:

目的]探讨血清脂蛋白(a)[Lp(a)]水平与新发ST段抬高型心肌梗死(STEMI)患者高血栓负荷(HTB)的相关性及其预测作用。 [方法]回顾性收集2021—2023年因持续胸痛于盐城市第一民医院胸痛中心就诊的新发前降支血管病变的STEMI患者281例。对患者采用TIMI血栓分级,其中1～3级为低血栓负荷(LTB)组,4～5级为HTB组,收集并比较两组患者基本临床资料、相关实验室检查结果；采用单因素、多因素二元Logistic回归分析HTB的危险因素,绘制ROC曲线判断Lp(a)对新发STEMI合并HTB的预测价值。 [结果]与LTB组相比,HTB组患者的男性比例较低(P＜0.05),白细胞计数(WBC)、中性粒细胞计数、中性粒细胞与淋巴细胞比值(NLR)、血清纤维蛋白降解产物(FDP)、D-二聚体(DD)、总胆红素(TB)、间接胆红素(IB)和Lp(a)水平较高(P＜0.05)。多因素Logistic回归分析结果表明,血清Lp(a)和TB水平升高及男性是新发STEMI患者HTB的独立危险因素(P＜0.05)。基于多因素回归分析结果绘制ROC曲线以获得其截断值,在Lp(a)阈值为288.2 mg/L时,灵敏度为0.560,特异度为0.837(AUC=0.735,95%CI:0.673～0.798,P＜0.001),血清Lp(a)水平联合TB后预测新发STEMI患者HTB的能力显著提升,AUC为0.787。 [结论]血清Lp(a)水平是新发STEMI患者合并HTB的独立危险因素,两者存在显著正相关。Lp(a)水平对STEMI患者发生HTB事件展现出显著的预测价值,有必要在一级预防层面控制Lp(a)水平。

Abstract:

Aim To investigate the correlation between lipoprotein(a)[Lp(a)] and high thrombus burden in patients with new-onset ST-segment elevation myocardial infarction (STEMI) and its predictive value. Methods The retrospective study included 281 patients with acute STEMI and left anterior descending artery lesions admitted to the Chest Pain Center of Yancheng No.1 People's Hospital from 2021 to 2023 due to persistent chest pain. Thrombus burden was graded using the TIMI thrombus classification:grades 1～3 as low thrombus burden (LTB) group and grades 4～5 as high thrombus burden (HTB) group. Baseline clinical data and laboratory results were collected and compared between the two groups. Univariate and multivariate binary Logistic regression analysis were performed to identify risk factors for HTB.ROC curves were plotted to evaluate the predictive value of Lp(a) for HTB in STEMI patients. Results Compared with the LTB group, the HTB group had a lower proportion of male patients and higher levels of white blood cell count (WBC), neutrophil count, neutrophil-to-lymphocyte ratio (NLR), fibrin degradation products (FDP), D-dimer (DD), total bilirubin (TB), indirect bilirubin (IB), and Lp(a) (P＜0.05). The results of multivariate Logistic regression analysis showed that elevated levels of serum Lp(a) and TB, as well as male gender, were independent risk factors for HTB in new-onset STEMI patients (P＜0.05). Based on the results of multivariate regression analysis, a receiver operating characteristic (ROC) curve was plotted to determine its cut-off value. When the Lp(a) threshold was 288.2 mg/L, the sensitivity was 0.560, the specificity was 0.837 (area under the curve(AUC)=0.5,5%CI:0.673～0.798, P＜0.001). The ability of serum Lp(a) level combined with TB to predict HTB in new-onset STEMI patients was significantly improved, with AUC value of 0.787. Conclusion Serum Lp(a) level is an independent risk factor for HTB in patients with new-onset STEMI, and there is a significant positive correlation between the two. Furthermore, Lp(a) level exhibits significant predictive value for the occurrence of HTB events in STEMI patients. It is imperative to control Lp(a) levels at the primary prevention level.