脂蛋白（a）联合纤维蛋白原在稳定型冠状动脉疾病患者中的预后效用：一项前瞻性大型队列研究。
Prognostic utility of lipoprotein(a) combined with fibrinogen in patients with stable coronary artery disease: a prospective, large cohort study.
作者信息
Zhang Yan, Jin Jing-Lu, Cao Ye-Xuan, Liu Hui-Hui, Zhang Hui-Wen, Guo Yuan-Lin, Wu Na-Qiong, Gao Ying, Hua Qi, Li Yan-Fang, Xu Rui-Xia, Cui Chuan-Jue, Liu Geng, Dong Qian, Sun Jing, Li Jian-Jun
机构信息
Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China.
Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
出版信息
J Transl Med. 2020 Oct 1;18(1):373. doi: 10.1186/s12967-020-02546-y.
BACKGROUND
Elevated lipoprotein(a) [Lp(a)] and fibrinogen (Fib) are both associated with coronary artery disease (CAD). The atherogenicity of Lp(a) can be partly due to the potentially antifibrinolytic categories. We hypothesize that patients with higher Lp(a) and Fib may have worse outcomes.
METHODS
In this prospective study, we consecutively enrolled 8,417 Chinese patients with stable CAD from March 2011 to March 2017. All subjects were divided into 9 groups according to Lp(a) (Lp(a)-Low, Lp(a)-Medium, Lp(a)-High) and Fib levels (Fib-Low, Fib-Medium, Fib-High) and followed up for CVEs, including nonfatal acute myocardial infarction, stroke, and cardiovascular mortality. Kaplan-Meier, Cox regression and C-statistic analyses were performed.
RESULTS
During a median of 37.1 months' follow-up, 395 (4.7%) CVEs occurred. The occurrence of CVEs increased by Lp(a) (3.5 vs. 5.3 vs. 5.6%, p = 0.001) and Fib (4.0 vs. 4.4 vs. 6.1%, p < 0.001) categories. When further classified into 9 groups by Lp(a) and Fib levels, the CVEs were highest in the 9th (Lp(a)-High and Fib-High) compared with the 1st (Lp(a)-Low and Fib-Low) group (7.2 vs. 3.3%, p < 0.001). The highest risk of subsequent CVEs was found in the 9 group (HR 2.656, 95% CI 1.628-4.333, p < 0.001), which was more significant than Lp(a)-High (HR 1.786, 95% CI 1.315-2.426, p < 0.001) or Fib-High (HR 1.558, 95% CI 1.162-2.089, p = 0.003) group. Moreover, adding the combined Lp(a) and Fib increased the C-statistic by 0.013.
CONCLUSION
Combining Fib and Lp(a) enhance the prognostic value for incident CVEs beyond Lp(a) or Fib alone.
背景
脂蛋白(a)[Lp(a)]和纤维蛋白原(Fib)升高均与冠状动脉疾病(CAD)相关。Lp(a)的致动脉粥样硬化性可能部分归因于其潜在的抗纤溶特性。我们假设Lp(a)和Fib水平较高的患者可能预后更差。
方法
在这项前瞻性研究中，我们连续纳入了2011年3月至2017年3月期间8417例中国稳定型CAD患者。所有受试者根据Lp(a)(低Lp(a)、中Lp(a)、高Lp(a))和Fib水平(低Fib、中Fib、高Fib)分为9组，并对心血管事件(CVE)进行随访，包括非致命性急性心肌梗死、中风和心血管死亡。进行了Kaplan-Meier、Cox回归和C统计分析。
结果
在中位37.1个月的随访期间，发生了395例(4.7%)CVE。CVE的发生率随Lp(a)(3.5%对5.3%对5.6%，p=0.001)和Fib(4.0%对4.4%对6.1%，p<0.001)水平升高而增加。当根据Lp(a)和Fib水平进一步分为9组时，第9组(高Lp(a)和高Fib)的CVE发生率高于第1组(低Lp(a)和低Fib)(7.2%对3.3%，p<0.001)。第9组随后发生CVE的风险最高(HR 2.656，95%CI 1.628-4.333，p<0.001)，这比高Lp(a)组(HR 1.786，95%CI 1.315-2.426，p<0.001)或高Fib组(HR 1.558，95%CI 1.162-2.089，p=0.003)更显著。此外，联合Lp(a)和Fib可使C统计量增加0.013。
结论
联合Fib和Lp(a)可增强对新发CVE的预后评估价值，超过单独的Lp(a)或Fib。
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