中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (06): 447-451.doi: 10.3969/j.issn.1671-4091.2025.06.002

• 临床研究 • 上一篇    下一篇

血浆脂蛋白相关磷脂酶A2在预测慢性肾脏病患者心血管事件中的作用

赖艳红   钟浩文    谢 娜   吴松钊   梁 翔   苏晓燕   

  1. 523110 东莞，1东莞东华医院肾内科
  • 收稿日期:2024-09-30 修回日期:2025-04-04 出版日期:2025-06-12 发布日期:2025-06-12
  • 通讯作者: 苏晓燕 E-mail:suxiaoyan769@hotmail.com
  • 基金资助:
    东莞市社会发展科技面上项目(20221800903262)

Predictive value of plasma lipoprotein-associated phospholipase A2 in major adverse cardiovascular events among patients with chronic kidney disease

LAI Yan-hong, ZHONG Hao-wen, XIE Na, WU Song-zhao, LIANG Xiang, SU Xiao-yan   

  1. Department of Nephrology, Dongguan Tungwah Hospital, Dongguan 523110, China.
  • Received:2024-09-30 Revised:2025-04-04 Online:2025-06-12 Published:2025-06-12
  • Contact: 523110 东莞，1东莞东华医院肾内科 E-mail:suxiaoyan769@hotmail.com

摘要： 目的 分析慢性肾脏病(chronic kidney disease，CKD) G3～5患者主要不良心血管事件(major adverse cardiovascular events，MACE)的危险因素，探讨血浆脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2，Lp-PLA2)对其MACE发生的预测价值。 方法  采用回顾性研究，选取2017年11月─2022年12月在东莞东华医院诊断CKD G3～5的患者，其中确诊MACE和未确诊MACE的患者各106例，比较2组间Lp-PLA2水平及各临床指标的差异，用Logistic回归分析MACE发生的危险因素，使用ROC曲线分析Lp-PLA2预测MACE事件的准确性。 结果  212例CKD G3～5患者中，MACE组Lp-PLA2高于非MACE组(t=8.909，P＜0.001)。Logistic回归分析显示除年龄及性别外，Lp-PLA2是该人群MACE发生的独立危险因素，优势比为1.026。亚组分析显示年长(OR=1.027，95% CI:1.009～1.045，P=0.003)、非年长(OR=1.025，95% CI:1.013～1.037，P＜0.001)、男性(OR=1.019，95% CI:1.009～1.029，P＜0.001)、女性(OR=1.052，95% CI:1.021～1.084，P=0.001)、糖尿病(OR=1.027，95% CI:1.012～1.043，P＜0.001)及非糖尿病(OR=1.025，95% CI:1.012～1.037，P＜0.001)患者Lp-PLA2是MACE发生的独立危险因素。ROC曲线分析显示Lp-PLA2预测MACE发生的截断值为189 ng/ml(灵敏度60.4%，特异度95.3%)。 结论 Lp-PLA2是CKD G3～5患者MACE发生的独立危险因素，其具有较高的预测MACE发生的临床价值。

关键词: 血浆脂蛋白相关磷脂酶A2, 慢性肾脏病, 主要不良心血管事件, 危险因素

Abstract: Objective  To assess the risk factors associated with major adverse cardiovascular events (MACE) in patients diagnosed with stages 3-5 chronic kidney disease (CKD), and to evaluate the predictive value of plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) for MACE within this specific patient population.  Methods  In this retrospective study, we enrolled a total of 212 patients diagnosed with CKD stages 3-5 at Dongguan Tungwah Hospital between November 2017 and December 2022. Among the two groups: 106 patients with confirmed MACE and an equal number of patients without MACE. We compared the differences in Lp-PLA2 levels and various clinical indicators between the two groups, employing logistic regression analysis to identify the risk factors associated with MACE. Additionally, we utilized ROC curve analysis to evaluate the predictive accuracy of Lp-PLA2 for MACE events.  Results  The Lp-PLA2 levels were significantly elevated in the MACE group compared to the non-MACE group (252.769±138.053 vs. 128.984±37.499，t=8.909，F=81.964，Z=-8.331， P＜0.001) among CKD stages 3-5 patients. Logistic regression analysis revealed that, besides age and sex, Lp-PLA2 independently contributed as a risk factor for MACE in CKD stages 3-5 patients with an odds ratio of 1.026. The analysis of age subgroups (elderly OR=1.027，95% CI:(1.009～1.045), P=0.003; non-elderly OR=1.025, 95% CI:(1.013～1.037), P＜0.001), gender subgroups [male OR=1.019, 95% CI: (1.009～1.029), P＜0.001; female OR=1.052, 95% CI:(1.021～1.084), P=0.001], and diabetes subgroup [diabetes OR=1.027, 95% CI: (1.012～1.043), P＜0.001; non-diabetes OR=1.025, 95% CI:(1.012～1.037), P＜0.001] revealed that Lp-PLA2 served as an independent risk factor for MACE. ROC curve analysis demonstrated that a cutoff value of 189 ng/ml for Lp-PLA2 predicted MACE with a sensitivity of 60.4% and specificity of 95.3%. Conclusions  The Lp-PLA2 enzyme is an independent risk factor for MACE in CKD stages 3-5 patients, and it holds significant clinical value in predicting the occurrence of MACE in this patient population.

Key words: Plasma lipoprotein-associated phospholipase A2, Chronic kidney disease, Major adverse cardiovascular events, Risk factors

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