2022 年第 7 期 第 17 卷

脂蛋白a对心房颤动患者住院期间发生急性心肌梗死和卒中风险的影响

Impact of lipoprotein a on the risk of acute myocardial infarction and stroke in patients with atrial fibrillation during hospital stay

作者：王海燕1钟鹏2白英3

英文作者：Wang Haiyan1 Zhong Peng2 Bai Ying3

单位：1首都医科大学附属北京世纪坛医院神经与精神科，北京100038；2首都医科大学附属北京友谊医院超声科，北京100050；3首都医科大学附属北京同仁医院心血管中心，北京100730

英文单位：1Department of Neurology and Psychiatry Beijing Shijitan Hospital Capital Medical University Beijing 100038 China; 2Department of Ultrasound Beijing Friendship Hospital Capital Medical University Beijing 100050 China; 3Cardiovascular Center Beijing Tongren Hospital Capital Medical University Beijing 100730 China

关键词：心房颤动；脂蛋白a；急性心肌梗死；卒中

英文关键词：

• 摘要：

• 目的 探讨脂蛋白a对心房颤动患者住院期间发生急性心肌梗死（AMI）和卒中风险的影响。方法 回顾性分析2008年9月至2018年12月在首都医科大学附属北京同仁医院和首都医科大学附属北京友谊医院首次住院并诊断为心房颤动患者的病历资料。根据脂蛋白a水平将患者分为≥300 mg/L组和＜300 mg/L组。收集患者资料，采用Pearson相关性分析方法分析脂蛋白a与其他实验室检查指标的相关性，使用Logistic回归方法分析脂蛋白a与住院期间AMI和卒中的关系。结果 本研究共纳入4 516例有脂蛋白a结果的心房颤动患者。其中脂蛋白a≥300 mg/L组1 032例，＜300 mg/L组3 484例。脂蛋白a≥300 mg/L组的患者年龄，高血压、慢性肾脏病(Ⅲ～Ⅳ期)、陈旧性心肌梗死、既往经皮冠状动脉介入或冠状动脉旁路移植术、慢性肺病病史、贫血、恶性肿瘤病史比例和CHA2DS2-VASc评分均高于＜300 mg/L组，差异均有统计学意义（均P＜0.05）。脂蛋白a水平与红细胞沉降率(r=0.161、P＜0.001)、空腹血糖(r=0.051、P=0.001)、糖化血红蛋白(r=0.051、P=0.004)、血小板计数(r=0.060、P＜0.001)水平呈正相关，而与三酰甘油(r=-0.047、P=0.002)、血红蛋白(r=-0.093、P＜0.001)水平呈负相关。住院期间，脂蛋白a＜300 mg/L组发生AMI 297例，卒中276例，≥300 mg/L组发生AMI 169例，卒中94例。单因素和多因素分析结显示，脂蛋白a≥300 mg/L增加AMI的发生风险（单因素分析：比值比=2.101，95%置信区间：1.715～2.575，P＜0.001；多因素分析：比值比=2.031，95%置信区间：1.639～2.517，P＜0.001），而与卒中发生风险无相关性（单因素分析：比值比=1.165，95%置信区间：0.912～1.488,P=0.223；多因素分析：比值比=1.159，95%置信区间：0.900～1.493，P=0.253）。结论 在心房颤动患者中，脂蛋白a≥300 mg/L增加住院期间AMI风险，而不影响卒中风险。

• Objective To investigate the effect of lipoprotein a ［Lp(a)］ on the risk of acute myocardial infarction (AMI) and stroke in patients with atrial fibrillation during hospital stay. Methods The medical records of patients first hospitalized and diagnosed with atrial fibrillation in Beijing Tongren Hospital, Capital Medical University and Beijing Friendship Hospital, Capital Medical University from September 2008 to December 2018 were analyzed retrospectively. The patients were divided into ≥300 mg/L group and ＜300 mg/L group according to the level of Lp(a). The data of patients were collected. Pearson correlation analysis was used to analyze the correlation between Lp(a) and other laboratory indexes. Logistic regression analysis was used to analyze the relationship of Lp(a) with AMI and stroke during hospitalization. Results A total of 4 516 patients with atrial fibrillation who had Lp(a) reports were included in this study. There were 1 032 cases in Lp(a) ≥300 mg/L group and 3 484 cases in Lp(a) ＜300 mg/L group. The age, proportions of hypertension, chronic kidney disease (CKD) (stage Ⅲ-Ⅳ), old myocardial infarction (OMI), previous percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), history of chronic lung disease, anemia and malignant tumor, and CHA 2DS  2-VASc score in Lp(a) ≥300 mg/L group were significantly higher than those in Lp(a) ＜300 mg/L group (all P＜0.05). The level of Lp(a) was positively correlated with erythrocyte sedimentation rate(r=0.161, P＜0.001), fasting blood glucose(r=0.051, P=0.001), glycosylated hemoglobin(r=0.051, P=0.004) and platelet count(r=0.060, P＜0.001), while it was negatively correlated with triacylglycerol(r=-0.047, P=0.002) and hemoglobin(r=-0.093, P＜0.001). During hospitalization, 297 cases of AMI and 276 cases of stroke occurred in Lp(a) ＜300 mg/L group, and 169 cases of AMI and 94 cases of stroke occurred in Lp(a) ≥300 mg/L group. Univariate and multivariate analysis showed that Lp(a) ≥300 mg/L increased the risk of AMI（univariate analysis：odds ratio=2.101，95% confidence interval：1.715-2.575，P＜0.001；multivariate analysis：odds ratio=2.031，95% confidence interval：1.639-2.517，P＜0.001）, however, it had nothing to do with the risk of stroke（univariate analysis： odds ratio=1.165， 95% confidence interval： 0.912-1.488,P=0.223； multivariate analysis： odds ratio=1.159， 95% confidence interval： 0.900-1.493，P=0.253）. Conclusions In patients with atrial fibrillation, Lp(a) ≥300 mg/L increases the risk of AMI during hospitalization without affecting the risk of stroke.