老年内科住院病人血清脂蛋白(a)与静脉血栓栓塞症风险的相关性研究

doi:10.3969/j.issn.1003-9198.2024.07.014

摘要/Abstract

摘要： 目的探讨老年内科住院病人血清脂蛋白(a)[Lp(a)]水平与静脉血栓栓塞症(VTE)风险的相关性。方法收集2021年1—6月就诊于河北省人民医院老年内科的病人246例,根据Padua评分分为VTE风险低危组(<4分),VTE风险高危组(≥4分)。收集2组的临床资料,并对比2组病人Lp(a)水平的差异。应用Spearman相关分析研究Lp(a)和Padua评分的相关性,应用多因素Logistic回归分析老年内科住院病人VTE高风险的相关因素,并进一步利用ROC曲线分析 Lp(a)对VTE风险的预测价值。结果 VTE风险高危组的年龄及Lp(a)、D-二聚体(D-D)水平明显高于低危组(P<0.01);Lp(a)水平与Padua评分、D-D均呈正相关(r分别为0.427、0.225,均P<0.01)。多因素Logistic回归分析表明,Lp(a)、D-D、年龄均与老年内科住院病人VTE风险密切相关(均P<0.01)。ROC曲线分析显示,Lp(a)评估老年内科住院病人VTE高风险的AUC为0.742,截断值为268.5 mg/L,敏感度为66.0%,特异度为76.0%。结论 Lp(a)水平与老年内科住院病人VTE风险明显相关。

关键词: 老年人, 脂蛋白(a), Padua评分, 静脉血栓栓塞症

Abstract: Objective To investigate the correlation between the level of lipoprotein(a)[Lp(a)] and the risk of venous thrombus embolism(VTE) in the elderly inpatients. Methods A total of 246 patients admitted to Department of Geriatrics of Hebei General Hospital from January to June 2021 were divided into low-risk VTE group(<4 points) and high-risk VTE group(≥4 points) according to Padua score. The clinical data and the level of Lp(a) were collected and compared between the two groups. Spearman correlation analysis was used to analyze the correlation between Lp(a) and Padua score. Multivariate Logistic regression analysis was used to analyze the influencing factors for the risk of VTE in the elderly inpatients. The predictive value of Lp(a) for VTE was analyzed by receiver operating characteristic(ROC) curve. Results The levels of age, Lp(a) and D-dimer(D-D) in the high-risk VTE group were significantly higher than those in the low-risk group(P<0.01). The level of Lp(a) was positively correlated with Padua score and D-D(r=0.427, 0.225; P<0.01). Multivariate Logistic regression analysis showed that Lp(a), D-D and age were the risk factors for VTE in the elderly inpatients(P<0.01). ROC curve showed that the area under curve(AUC) of Lp(A) to evaluate the high risk of VTE was 0.742, with the cut-off value of 268.5 mg/L, the sensitivity of 66.0%, and the specificity of 76.0%. Conclusions Lp(a) level is significantly correlated with the risk of VTE in the elderly inpatients.

Key words: aged, lipoprotein(a), Padua score, venous thrombus embolism

中图分类号:

R 543.6

孔超敏, 吕彩霞, 姚丽霞, 苑晓烨, 王素星, 邵伟华, 白雪冬, 吴思思, 杨爽, 李芳. 老年内科住院病人血清脂蛋白(a)与静脉血栓栓塞症风险的相关性研究[J]. 实用老年医学, 2024, 38(7): 705-708.

KONG Chaomin, LYV Caixia, YAO Lixia, YUAN Xiaoye, WANG Suxing, SHAO Weihua, BAI Xuedong, WU Sisi, YANG Shuang, LI Fang. Correlation between serum lipoprotein(a) and the risk of venous thrombus embolism in elderly inpatients[J]. Practical Geriatrics, 2024, 38(7): 705-708.

参考文献

[1] CHEN X L,HUANG J L, LIU J X,et al.Venous thromboembolism risk factors and prophylaxis of elderly intensive care unit patients in a Chinese general hospital[J].Ann Palliat Med,2021,10(4):4453-4462.
[2] WANG C W,SU L L,TAO S B,et al. An increased serum level of lipoprotein(a) is a predictor for deep vein thrombosis in patients with spinal cord injuries[J].World Neurosurg,2016,87:607-612.
[3] 王广文,刘超,丛洪良.脂蛋白(a)和PCSK9抑制剂降低脂蛋白(a)研究进展[J].中华老年医学杂志,2019,38(9):1068-1072.
[4] DENTALI F, GESSI V, MARCUCCI R, et al.Lipoprotein(a) as a risk factor for venous thromboembolism: a systematic review and meta-analysis of the literature[J]. Semin Thromb Hemost,2017,43(6):614-620.
[5] NAVE A H, VON ECKARDSTEIN A.Is lipoprotein(a) a risk factor for ischemic stroke and venous thromboembolism?[J].Clin Res Cardiol Suppl,2019,14(Suppl): 28-32.
[6] BARBAR S,NOVENTA F,ROSSETTO V,et al.A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score[J]. J ThrombHaemost,2010,8(11): 2450-24577.
[7] 朱杰,许小毛.老年恶性肿瘤合并静脉血栓栓塞症患者的临床特点及预后分析[J].中华老年医学杂志,2020,39(2):176-181.
[8] 内科住院患者静脉血栓栓塞症预防的中国专家建议写作组,中华医学会呼吸病学分会,中华医学会老年医学分会,等.内科住院患者静脉血栓栓塞症预防中国专家建议(2015)[J].中华老年医学杂志,2015,34(4):345-352.
[9] GOULD M K,GARCIA D A,WREN S M,et al.Prevention of VTE in nonorthopedic surgical patients [J].Chest,2012,141(Suppl 2):e227s-e277s.
[10] LABUDOVIC D,KOSTOVSKA I,TOSHESKA TRAJKOVSKA K,et al.Lipoprotein(a)-link between atherogenesis and thrombosis[J].Prague Med Rep,2019,120(2/3):39-51.
[11] KUNUTSOR S K, MAKIKALLIO T H, KAUHANEN J, et al.Lipoprotein(a) is not associated with venous thromboembolism risk[J]. Scand Cardiovasc J, 2019,53(3):125-132.
[12] GRESSENBERGER P, POSCH F, PECHTOLD M, et al.Lipoprotein(a) and pulmonary embolism severity-a retrospective data analysis[J]. Front Cardiovasc Med, 2022,9:808605.
[13] NURMOHAMED N S,COLLARD D,REESKAMP L F,et al. Lipoprotein(a), venous thromboembolism and COVID-19: a pilot study[J]. Atherosclerosis,2022,341:43-49.
[14] 中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中华心血管病杂志,2016,44(10):833-853.
[15] ANDERSON T J,GREGOIRE J,PEARSON G J,et al.2016 Canadian Cardiovascular Society Guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult[J].Can J Cardiol,2016,32(11):1263-1282.