2023 年第 2 期 第 18 卷

载脂蛋白A1对不稳定型心绞痛患者主要不良心血管事件的预测作用

Predictive effect of apolipoprotein A1 on major adverse cardiovascular events in patients with unstable angina pectoris

作者：李文玲1张雪鹤1刘芬1张冀鑫1张志扬1余小林2杨毅宁2李晓梅1

英文作者：Li Wenling1 Zhang Xuehe1 Liu Fen1 Zhang Jixin1 Zhang Zhiyang1 Yu Xiaolin2 Yang Yining2 Li Xiaomei1

单位：1新疆医科大学第一附属医院心脏中心，乌鲁木齐830054；2新疆维吾尔自治区人民医院心内科，乌鲁木齐830001

英文单位：1Heart Center， the First Affiliated Hospital of Xinjiang Medical University Urumqi 830054 China; 2Department of Cardiology Xinjiang Uygur Autonomous Region People′s Hospital Urumqi 830001 China

关键词：不稳定型心绞痛；载脂蛋白A1；主要不良心血管事件

英文关键词：

• 摘要：

• 目的 探讨载脂蛋白A1（ApoA1）对不稳定型心绞痛（UAP）患者主要不良心血管事件(MACE)的预测作用。方法 连续选取2016年12月1日至2019年12月15日于新疆医科大学第一附属医院心脏中心确诊为UAP的住院患者。收集患者年龄、性别、血常规、空腹血糖、血脂等基线资料。所有患者出院后持续随访48个月，根据MACE发生与否将患者分为MACE组和非MACE组。分析ApoA1对UAP患者发生MACE的预测作用。结果 本研究共纳入UAP患者333例，MACE组136例，非MACE组197例。MACE组男性、高血压病、糖尿病、肥胖比例、血小板计数、三酰甘油水平均高于非MACE组，ApoA1水平低于非MACE组［（1.11±0.22）g/L比（1.28±0.41）g/L］，差异均有统计学意义（均P＜0.05）。多因素Cox回归分析结果显示，ApoA1是UAP患者发生MACE的独立保护因素（P＜0.05）。受试者工作特征曲线分析结果显示，ApoA1预测UAP患者发生MACE的曲线下面积为0.631（95%置信区间：0.572~0.691，P＜0.001），截断值为1.16 g/L，敏感度为81%，特异度为59%。根据ApoA1截断值将333例患者分为低ApoA1组（ApoA1≤1.16 g/L，168例）和高ApoA1组（ApoA1＞1.16 g/L，165例）。Kaplan-Meier生存曲线分析结果显示，低ApoA1组累积生存率明显低于高ApoA1组，差异有统计学意义（Log-rank P=0.018）。结论 ApoA1对UAP患者MACE有一定的预测价值。

• Objective To investigate the predictive effect of apolipoprotein A1 (ApoA1) on major adverse cardiovascular events (MACE) in patients with unstable angina pectoris (UAP). Methods  Patients with UAP were consecutively enrolled in the First Affiliated Hospital of Xinjiang Medical University from December 1, 2016 to December 15, 2019. Baseline data such as age, gender, routine blood test, fasting blood glucose and blood lipid of patients were collected. All patients were continuously followed-up for 48 months after discharge from the hospital. According to whether MACE occurred or not, patients were divided into MACE group and non-MACE group. Predictive effect of ApoA1 on the occurrence of MACE in UAP patients was evaluated. Results  Totally 333 patients with UAP were enrolled, including 136 cases in MACE group and 197 cases in non-MACE group. Proportions of male, hypertension, diabetes mellitus, fat, platelet count, and the level of triacylglycerol in MACE group were higher than those in non-MACE group, and the level of ApoA1 in MACE group was lower than that in non-MACE group［（1.11±0.22）g/L vs （1.28±0.41）g/L］(all P<0.05). Multivariate Cox regression analysis showed that ApoA1 was an independent protective factor for MACE in patients with UAP (P<0.05). Receiver operating characteristic curve analysis showed that the area under the curve of ApoA1 predicting MACE in patients with UAP was 0.631 (95% confidence interval: 0.572-0.691, P<0.001), the cut-off ratio was 1.16 g/L, the sensitivity was 81% and the specificity was 59%. According to the cut-off ratio of ApoA1, 333 cases were divided into low-ApoA1 group (ApoA1≤1.16 g/L, 168 cases) and high-ApoA1 group (ApoA1>1.16 g/L, 165 cases). Kaplan-Meier survival curve analysis showed that the cumulative survival in low-ApoA1 group was lower than that in high-ApoA1 group (Log-rank P=0.018). Conclusion  ApoA1 has certein predictive value for MACE in patients with UAP.