血清脂蛋白a水平与二尖瓣环钙化的相关性分析

潘路华; 朱明利; 陈多学; 涂胜

doi:10.16766/j.cnki.issn.1674-4152.003715

血清脂蛋白a水平与二尖瓣环钙化的相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.003715

亳州市人民医院心内科，安徽亳州 236800

基金项目:

安徽高校自然科学研究重点项目 KJ2020A0336

详细信息

通讯作者:
涂胜，E-mail: tusheng77@163.com

中图分类号: R542.5
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出版历程
- 收稿日期: 2024-01-22

Correlation analysis between serum lipoprotein(a) levels and mitral annulus calcification

Department of Cardiovascular Medicine, the People ' s Hospital of Bozhou, Bozhou, Anhui 236800, China

摘要

摘要: 目的研究血清脂蛋白a[Lp(a)]与二尖瓣环钙化及其二尖瓣功能障碍之间的潜在联系。方法收集2022年1月—2023年11月于亳州市人民医院心血管内科住院并行冠脉CT血管成像(CTA)患者的临床资料，共131例，根据图像分析，分为二尖瓣环钙化(MAC)组(62例)及正常组(69例)。收集患者基线资料包括年龄、性别、高血压、糖尿病、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A、载脂蛋白B、血清脂蛋白a、肌酐、尿酸、同型半胱氨酸、服用他汀史等。比较2组临床基本资料及发生二尖瓣狭窄及反流的差异，分析MAC的危险因素及MAC引起的相关二尖瓣疾病的风险。结果二尖瓣环钙化组及正常组的LDL-C、Lp(a)差异有统计学意义(P < 0.001)。Logistic回归分析显示Lp(a)升高是MAC的独立危险因素(OR=1.256，95% CI：1.002~1.490, P=0.008)。重度MAC组与正常组、轻度MAC组、中度MAC组患者的Lp(a)水平差异均有统计学意义(P < 0.05)。MAC组及正常组二尖瓣狭窄发生率差异无统计学意义[8.06%(5/62) vs. 1.45%(1/69), P=0.165]，但MAC组比正常组二尖瓣反流发生率高[17.74%(11/62) vs. 4.35%(3/69), P=0.013]。结论 Lp(a)水平升高是二尖瓣环钙化的危险因素之一，MAC可能增加二尖瓣反流风险，建议对MAC患者应注意监测Lp(a)并加强控制Lp(a)水平，控制Lp(a)水平可能对预防二尖瓣环钙化及其相关二尖瓣疾病的发生具有潜在意义。
- 血清脂蛋白a /
- 二尖瓣环钙化 /
- 二尖瓣反流
Abstract: Objective This investigation delineates the potential correlation between serum Lipoprotein(a) [Lp(a)] levels, mitral annular calcification (MAC), and associated mitral valve dysfunction. Methods A retrospective analysis was conducted on the clinical data of 131 patients admitted to the Department of Cardiology at People ' s Hospital of Bozhou for coronary CT angiography (CTA) from January 2022 to November 2023. Based on image analysis, patients were divided into the MAC group (62 cases) and the normal group (69 cases). Comprehensive data collection encompassed demographic information (age, gender), medical history (hypertension, diabetes), and a spectrum of biochemical parameters including high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), Apolipoprotein A, Apolipoprotein B, Serum Lipoprotein(a), Creatinine, Uric Acid, Homocysteine, and history of statin use. The basic clinical data of the two groups were compared, focusing on the differences in the occurrence of mitral stenosis and regurgitation. The study also analyzed the risk factors for MAC and the risk of MAC-related mitral valve diseases. Results Significant differences were observed in the levels of LDL-C and Lp(a) between the MAC and the control group (P < 0.01). Logistic regression analysis identified Lp(a) as an independent risk factor for MAC (OR=1.256, 95% CI: 1.002-1.490, P=0.008). Lp(a) levels significantly differed between the normal group and both severe MAC and mild-to-moderate MAC groups (P < 0.05). The incidence of mitral stenosis did not differ significantly between the groups [8.06% (5/62) in the MAC group vs. 1.45% (1/69) in controls, P=0.165]. However, mitral regurgitation was significantly more prevalent in the MAC group [17.74% (11/62) in the MAC group vs. 4.35% (3/69) in controls, P=0.013]. Conclusion Elevated Lp(a) levels are significant risk factors for mitral annular calcification. The presence of MAC may increase the risk of mitral regurgitation. Monitoring and controlling Lp(a) levels in patients with MAC is crucial for preventing MAC progression and associated mitral valve diseases.
- Serum lipoprotein(a) /
- Mitral annulus calcification /
- Mitral regurgitation
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图 1 二尖瓣环钙化

根据冠脉CTA影像结果可见二尖瓣环处钙化，如红色箭头所示。

Figure 1. Mitral annulus calcification

下载: 全尺寸图片幻灯片

表 1 MAC组与正常组一般情况比较

Table 1. Comparison of patients' conditions between the MAC group and the normal group

项目	MAC组(n=62)	正常组(n=69)	统计量	P值
年龄(x±s，岁)	70.6±6.8	68.4±7.2	1.793^a	0.075
性别(男/女，例)	34/28	40/29	0.130^b	0.718
高血压病史[例(%)]	37(59.68)	42(60.87)	0.019^b	0.889
糖尿病病史[例(%)]	12(19.35)	13(18.84)	0.006^b	0.940
TC(x±s，mmol/L)	4.25±1.08	4.06±0.84	1.130^a	0.261
TG(x±s，mmol/L)	2.06±0.76	1.95±0.54	0.962^a	0.338
HDL-C(x±s，mmol/L)	1.20±0.26	1.18±0.23	0.467^a	0.641
LDL-C(x±s，mmol/L)	2.90±0.84	1.78±0.66	8.528^a	＜0.001
载脂蛋白A(x±s，mmol/L)	1.22±0.28	1.20±0.34	0.365^a	0.716
载脂蛋白B(x±s，mmol/L)	0.94±0.26	0.90±0.31	0.795^a	0.428
Lp(a)[M(P₂₅, P₇₅)，mg/L]	386.7(212.0, 623.6)	220.7(115.9, 400.7)	-3.531^c	＜0.001
肌酐(x±s，μmol/L)	80.27±26.03	78.36±22.19	0.453^a	0.651
尿酸(x±s，mmol/L)	360.52±110.26	348.27±102.35	0.659^a	0.511
Hcy(x±s，μmol/L)	14.40±6.28	12.82±5.36	1.553^a	0.123
服用他汀药物史[例(%)]	29(46.77)	25(36.23)	1.498^b	0.221
注：^a为t值，^b为χ²值, ^c为Z值。

下载: 导出CSV

表 2 MAC影响因素的多因素logistic回归分析

Table 2. Multivariate logistic regression analysis of MAC influencing factors

变量	B	SE	Waldχ²	P值	OR值	95% CI
Lp(a)	0.228	0.104	4.806	0.008	1.256	1.002~1.490
LDL-C	0.112	0.053	4.466	0.012	1.119	1.016~1.304
注：Lp(a)和LDL-C均为连续变量，以实际值赋值。

下载: 导出CSV

表 3 MAC组与正常组Lp(a)水平比较

Table 3. Comparison of Lp (a) levels between the MAC group and the normal group

组别	例数	Lp(a)[M(P₂₅, P₇₅)，mg/L]
轻度MAC	28	365.5(279.2, 531.1)^ab
中度MAC	20	426.5(296.5, 468.5)^ab
重度MAC	14	603.7(471.9, 749.9)^b
正常组	69	220.7(115.9, 400.7)^a
H值		26.110
P值		＜0.001
注：与重度MAC比较，^aP＜0.05；与正常组比较，^bP＜0.05。

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