脂蛋白(a)联合低密度脂蛋白胆固醇对老年钙化性主动脉瓣狭窄的预测价值^*

Predictive value of combined lipoprotein(a) and low-density lipoprotein cholesterol for calcific aortic valve stenosis in the elderly

摘要

目的 探讨低密度脂蛋白胆固醇(LDL-C)联合脂蛋白(a)[Lp(a)]对钙化性主动脉瓣狭窄的预测价值。方法 选取长春市中心医院2023年1月—2025年3月经心脏彩超诊断为钙化性主动脉瓣狭窄的老年患者60例作为狭窄组,同时于健康老年群体选择60例作为对照组。收集一般资料(年龄、性别、吸烟史等)及血脂指标[Lp(a)、LDL-C等],分析组间差异;采用Spearman秩相关系数分析Lp(a)/LDL-C与狭窄程度的相关性;采用多因素logistic回归模型分析各变量与钙化性主动脉瓣疾病发生的关系;采用ROC曲线分析各变量预测钙化性主动脉瓣疾病的效能。结果 两组的年龄、性别、Lp(a)、LDL-C、总胆固醇水平及吸烟史比较,差异均有统计学意义(P＜0.05)。Spearman秩相关系数分析显示,矫正年龄、性别后,Lp(a)/LDL-C与主动脉瓣峰值流速呈正相关(r=0.375,P＜0.001)。多因素logistic回归模型分析显示,矫正年龄、性别后,Lp(a)、LDL-C及Lp(a)/LDL-C均是钙化性主动脉瓣狭窄发生的独立危险因素(P＜0.05)。Lp(a)/LDL-C预测钙化性主动脉瓣疾病的ROC曲线下面积为0.756(95%CI:0.668～0.843)。结论 Lp(a)/LDL-C对钙化性主动脉瓣疾病的发生具有一定的预测价值。

Abstract

Objective To investigate the predictive value of combined lipoprotein(a) [Lp(a)] and low-density lipoprotein cholesterol (LDL-C) detection for calcific aortic valve stenosis in elderly patients. Methods A total of 60 elderly patients diagnosed with calcific aortic valve stenosis by echocardiography at Changchun Central Hospital from January 2023 to March 2025 were selected as the stenosis group, and 60 non-aortic stenosiselderly patients were included as the control group. General clinical data (age, gender,smoking history,etc) and lipid profiles[Lp(a),LDL-C,etc]were collected. Spearman correlation analysis was used to evaluate the relationship between the Lp(a)/LDL-C and the severity of stenosis (peak aortic jet velocity). Multivariate logistic regression was applied to identify independent risk factors for calcific aortic valve stenosis, and receiver operating characteristic (ROC) curve analysis was performed to assess the predictive performance of each variable. Results There were statistically significant differences in age, gender,Lp(a), LDL-C, total cholesterol levels, and smoking history between the two groups(P＜0.05). Spearman correlation analysis revealed a positive correlation between the Lp(a)/LDL-C and peak aortic jet velocitywhen age and gender were corrected(r=0.375,P＜0.001). Logistic regression analysis showed that Lp(a), LDL-C, and Lp(a)/LDL-C were all independent risk factors for calcific aortic valve stenosis when age and gender were corrected(P＜0.05). The area under the ROC curve of the Lp(a)/LDL-C for predicting calcific aortic valve stenosis was 0.756(95% CI:0.668～0.843). Conclusion Combined detection of Lp(a) and LDL-C has certain predictive value for the occurrence of calcific aortic valve stenosis in elderly patients.

关键词

脂蛋白(a) / 低密度脂蛋白胆固醇 / 钙化性主动脉瓣狭窄 / 诊断价值

Key words

Lipoprotein(a) / Low-density lipoprotein cholesterol / Calcific aortic valve stenosis / Diagnostic value