Abstract:

Objective　To analyze the value of lipoprotein a (Lp-a) and apolipoprotein B (ApoB) combined with vitamin D (VD) in evaluating the severity degree and short-term prognosis of coronary heart disease. Methods　Between May 2020 and April 2022, 105 patients with coronary heart disease admitted to Xianyang Hospital, Yan'an University were selected as the study group, and another 102 healthy people who were examined in our hospital during the same period were selected as the control group. There were 65 males and 40 females in the study group, aged 40-71 (55.62±7.85) years, 45 cases of single-vessel disease, 39 cases of double-vessel disease, and 21 cases of three-vessel disease. There were 63 males and 39 females in the control group, aged 39-72 (55.39±8.47) years. The serum level of VD was measured by enzyme linked immunosorbent assay (ELISA), and the serum levels of Lp-a and ApoB were detected by immunoturbidimetric assay. Spearman correlation analysis was used to analyze the correlations between Lp-a, ApoB, and VD levels and the severity degree of coronary artery disease. The patients were followed up for 1 year and the death of the study group was counted. The prognostic value of Lp-a, ApoB, and VD in coronary heart disease was analyzed by the receiver operating characteristic curve (ROC). Independent sample t test and χ² test were performed. Results　The serum Lp-a and ApoB levels in the study group were higher than those in the control group, while the serum VD level was lower than that in the control group (all P<0.05). Serum Lp-a and ApoB levels in the three-vessel disease group were higher than those in the double-vessel disease group > those in the single-vessel disease group, while the VD level was lower than that in the double-vessel disease group < that in the single-vessel disease group (all P<0.05). Correlation analysis showed that Lp-a and ApoB levels were positively correlated with the severity of coronary artery disease (r=0.607 and 0.601, both P<0.05), and the VD level was negatively correlated with the severity of coronary artery disease (r=-0.461, P<0.05). The 1-year mortality of the three-vessel disease group was higher than that in the double-vessel disease group and that in the single-vessel disease group [28.57% (6/21) vs. 10.26% (4/39) vs. 6.67% (3/45)] (P<0.05). ROC analysis showed that the areas under the curves of Lp-a, ApoB, VD, and combined detection to evaluate the prognosis of coronary heart disease were 0.729, 0.737, 0.793, and 0.838, respectively, the sensitivities were 60.1%, 60.0%, 71.3%, and 79.1%, respectively, and the specificities were 77.8%, 74.8%, 62.8%, and 79.4%, respectively. Conclusion　Lp-a, ApoB, and VD are closely related to the severity of coronary heart disease, they can be used to evaluate the short-term prognosis of coronary heart disease, and the combined detection of Lp-a, ApoB, and VD is more effective.

Key words:

Coronary heart disease, Lipoprotein a, Apolipoprotein B, Vitamin D, Severity degree, Short-term prognosis

摘要：

目的　分析脂蛋白a（Lp-a）、载脂蛋白B（ApoB）联合维生素D（VD）检测对冠心病严重程度及短期预后的评估价值。方法　以2020年5月至2022年4月延安大学咸阳医院收治的105例冠心病患者为研究组，另选取同期于本院接受检查的102例健康人群作为对照组。研究组男65例，女40例；年龄40～71（55.62±7.85）岁；单支病变45例，双支病变39例，三支病变21例。对照组男63例，女39例；年龄39～72（55.39±8.47）岁。以酶联免疫吸附法测定两组血清VD水平，以免疫比浊法检测两组血清中Lp-a、ApoB水平，并采用Spearman相关性分析法分析Lp-a、ApoB、VD水平与冠状动脉病变程度的相关性。随访1年，统计研究组患者死亡情况。采用受试者操作特征曲线（ROC）分析Lp-a、ApoB、VD对冠心病预后的评估价值。行独立样本t检验、χ²检验。结果　研究组血清Lp-a和ApoB水平高于对照组，VD水平低于对照组（均P<0.05）。三支病变组患者血清Lp-a、ApoB水平>双支病变组>单支病变组，VD水平<双支病变组<单支病变组（均P<0.05）。相关性分析显示，Lp-a、ApoB水平与冠状动脉病变程度呈正相关（r=0.607、0.601，均P<0.05），VD水平与冠状动脉病变程度呈负相关（r=-0.461，P<0.05）。三支病变组患者1年病死率>双支病变组>单支病变组［28.57%（6/21）比10.26%（4/39）比6.67%（3/45）］（P<0.05）。ROC分析显示，Lp-a、ApoB、VD水平及联合检测评估冠心病患者预后的曲线下面积分别为0.729、0.737、0.793、0.838，灵敏度分别为60.1%、60.0%、71.3%、79.1%，特异度分别为77.8%、74.8%、62.8%、79.4%。结论　Lp-a、ApoB、VD与冠心病严重程度密切相关，均可用于冠心病患者短期预后的评估，且三者联合检测评估效果更佳。

关键词:

冠心病, 脂蛋白a, 载脂蛋白B, 维生素D, 严重程度, 短期预后