摘要
背景原发性高血压(EH)被认为是多种心脑血管疾病的独立危险因素,EH患者中动脉僵硬度增加与心脑血管发病率和死亡率有关,但目前临床缺乏更多的指标来帮助评估EH患者心功能的情况。目的探讨EH患者脂蛋白相关磷脂酶A2(Lp-PLA2)水平和动态动脉僵硬指数(AASI)对左心功能的预测价值。方法选取2020年在郑州大学第二附属医院心血管内科住院的216例患者为研究对象,按是否患有EH分为高血压组(观察组,122例)和无高血压组(对照组,94例)。收集患者性别、年龄、体质量、体质指数(BMI)、吸烟史、饮酒史、糖尿病史、血脂异常史等基线资料,测定尿酸(UA)、肌酐(Cr)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)等生化指标。检测Lp-PLA2水平和AASI,并与左心室射血分数(LVEF)及N末端B型尿钠肽前体(NT-proBNP)作相关性分析。根据LVEF水平及中位NT-proBNP水平,将两组患者分为LVEF≥50%亚组和LVEF<50%亚组,以及NT-proBNP≥514 ng/L亚组和NT-proBNP<514 ng/L亚组,比较LVEF亚组间及NT-proBNP亚组间Lp-PLA2水平和AASI的差异;采用多因素Logistic回归分析探讨LVEF、NT-proBNP及EH的影响因素,采用受试者工作特征曲线(ROC曲线)分析Lp-PLA2、AASI对心力衰竭的诊断价值。结果两组年龄、UA、Lp-PLA2、AASI、SBP、NT-ProBNP、LVEF比较,差异有统计学意义(P<0.05)。线性回归分析显示,观察组Lp-PLA2水平、AASI与LVEF水平呈负相关(r=-0.437、-0.580,P=0.036、0.001);Lp-PLA2水平、AASI与NT-ProBNP水平呈正相关(r=0.309、0.519,P=0.038、0.041)。对照组Lp-PLA2水平、AASI与LVEF无线性相关关系(r=0.027、0.019,P=0.601、0.372),与NT-ProBNP也无线性相关关系(r=0.033、0.058,P=0.460、0.703)。多因素Logistic回归分析结果显示,EH史、Lp-PLA2、AASI是LVEF的影响因素(P<0.05),Lp-PLA2、AASI是NT-ProBNP的影响因素(P<0.05),吸烟史、Lp-PLA2、AASI是EH的影响因素(P<0.05)。Lp-PLA2水平预测EH患者发生心力衰竭的ROC曲线下面积为0.637〔95%CI(0.480,0.800)〕,最佳截断值为115.77μg/L,灵敏度为64%,特异度为70%;AASI预测EH患者发生心力衰竭的ROC曲线下面积为0.861〔95%CI(0.750,0.973)〕,最佳截断值为0.535,灵敏度为82%,特异度为85%。结论EH患者较无EH患者心功能更差。Lp-PLA2水平、AASI可独立预测EH患者左心功能,可能成为临床监测左心功能的有效指标。
Background Essential hypertension is supposed to be independently associated with increased risk of multiple cardio-cerebrovascular diseases,and increased arterial stiffness in essential hypertension is associated with increased cardiovascular morbidity and mortality.However,there is a lack of adequate indicators to evaluate the cardiac function of essential hypertension patients.Objective To investigate the predictive value of lipoprotein-associated phospholipase A2(Lp-PLA2)concentration and ambulatory arterial stiffness index(AASI)on left ventricular function in patients with essential hypertension.Methods A total of 216 inpatients(including 122 with essential hypertension and 94 without)were selected from Cardiovascular Department the Second Affiliated Hospital of Zhengzhou University in 2020.Data were collected,including general information(gender,age,body weight,BMI,history of smoking,drinking,diabetes,and dyslipidemia),and biomarkers〔serum uric acid(SUA),creatinine,fasting plasma glucose,glycosylated hemoglobin,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,C-reactive protein,NT-proBNP,Lp-PLA2,AASI,and left ventricular ejection fraction(LVEF)〕.The concentrations of Lp-PLA2 and AASI were compared between LVEF≥50%and<50%subgroups to explore the association of them with LVEF,and between NT-proBNP≥514 ng/L and<514 ng/L subgroups(stratified by the median value NT-proBNP)to explore the association of them with NT-proBNP.Multivariate Logistic regression was used to explore risk factors of LVEF,NT-proBNP and hypertension.ROC analysis was conducted to assess the predictive value of Lp-PLA2 and AASI for heart failure.Results Patients with and without essential hypertension showed significant differences in mean age,and SUA,Lp-PLA2,AASI,SBP,NT-proBNP and LVEF(P<0.05).Linear regression analysis indicated that LVEF was negatively correlated with Lp-PLA2(r=-0.437,P=0.036),and AASI(r=-0.580,P=0.001),but NT-ProBNP was positively correlated with Lp-PLA2(r=0.309,P=0.038)and AASI(r=0.519,P=0.041)in patients with essential hypertension.However,in those without essential hypertension,LVEF showed no linear correlation with Lp-PLA2(r=0.027,P=0.601)and AASI(r=0.019,P=0.372),and NT-ProBNP also showed no linear correlation with Lp-PLA2(r=0.033,P=0.460),and AASI(r=0.058,P=0.703).Multivariate Logistic regression analysis revealed that hypertension history,Lp-PLA2 and AASI were associated with LVEF(P<0.05),Lp-PLA2 and AASI were associated with NT-proBNP,and Lp-PLA2,smoking history and AASI were associated with essential hypertension(P<0.05).The AUC of Lp-PLA2 concentration in predicting heart failure in essential hypertension was 0.637〔95%CI(0.48,0.80)〕,with the optimal cutoff value of 115.77μg/L(sensitivity:64%;specificity:70%).The AUC AASI in predicting heart failure in essential hypertension was 0.861〔95%CI(0.750,0.973)〕,with the optimal cutoff value of 0.535(sensitivity:82%;specificity:85%).Conclusion Essential hypertension may be associated with poorer cardiac function.Lp-PLA2 or AASI may be an effective independent predictor for left ventricular function in essential hypertension.
作者
信彩凤
张强
杨丽红
孙彩红
姚芳
刘方方
费思杰
XIN Caifeng;ZHANG Qiang;YANG Lihong;SUN Caihong;YAO Fang;LIU Fangfang;FEI Sijie(Cardiovascular Department,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China;Henan Provincial People's Hospital,Zhengzhou 450003,China)
出处
《中国全科医学》
CAS
北大核心
2021年第29期3684-3691,共8页
Chinese General Practice
基金
河南省科技攻关项目(182102310509)。
关键词
原发性高血压
动态血压监测
1-烷基-2-乙酰甘油磷酸胆碱酯酶
动态动脉硬化指数
左心功能
预测价值
Essential hypertension
Dynamic blood pressure monitoring
1-Alkyl-2-acetylglycerophosphocholine esterase
Dynamic atherosclerosis index
The left ventricular function
Predictive value
作者简介
通信作者:张强,主任医师,E-mail:zq3397@163.com。
