Clin Lab. 2022 Aug 1;68(8). doi: 10.7754/Clin.Lab.2021.211038.
The aim was to investigate the predictive value of serum lipoprotein-associated phospholipase A2 (Lp-PLA2) for type 2 diabetes mellitus (T2DM) complicated with metabolic syndrome (MS) in elderly patients.
A total of 296 patients with T2DM admitted from January 2019 to January 2021 were enrolled and assigned to MS group (n = 181) and non-MS group (n = 115). Their clinical data and laboratory test results were compared. Logistic regression analysis was employed to identify independent risk factors for MS in T2DM patients. Spearman's analysis was utilized to explore the correlations between serum Lp-PLA2 level and detection indicators. The predictive value of Lp-PLA2 for MS was analyzed by plotting receiver operating characteristic (ROC) curve, and Cox regression model was applied to explore the correlation of serum Lp-PLA2 level with MS. The results of data subjected to multivariate analysis were used to construct prediction models.
The incidence rate of MS was 61.15% in T2DM patients. MS group had a significantly higher serum level of Lp-PLA2 than non-MS group (p < 0.05). Serum Lp-PLA2 was significantly positively correlated to FBG, glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), FINS, and HOMA-IR, but significantly negatively associated with LDL-C (p < 0.05). The area under the ROC curve of Lp-PLA2 for predicting MS in T2DM patients was 0.724 (95% CI: 0.625 - 0.826, p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of Lp-PLA2 with an optimal cutoff value of 82.96 ng/mL were 73.7%, 85.4%, 77.56%, and 93.24%, respectively. TC, TG, HDL-C, HbA1c, and Lp-PLA2 were independent risk factors for MS (p < 0.05). The area under the ROC curve of the risk prediction model established based on these indicators was 0.823, and the cutoff value, Youden index, sensitivity, and specificity were 0.219, 0.656, 78.87%, and 87.66%, respectively, indicating higher predictive value.
Increased serum Lp-PLA2 level is an independent risk factor for MS in T2DM patients. Lp-PLA2 (82.87 ng/mL) has high predictive value for MS.
本研究旨在探讨血清脂蛋白相关磷脂酶 A2（Lp-PLA2）对老年 2 型糖尿病（T2DM）合并代谢综合征（MS）的预测价值。
选取 2019 年 1 月至 2021 年 1 月期间收治的 296 例 T2DM 患者，根据是否合并 MS 分为 MS 组（n=181）和非 MS 组（n=115）。比较两组患者的临床资料和实验室检查结果。采用 Logistic 回归分析 T2DM 患者合并 MS 的独立危险因素。采用 Spearman 分析探讨血清 Lp-PLA2 水平与检测指标的相关性。绘制受试者工作特征（ROC）曲线分析 Lp-PLA2 对 MS 的预测价值，并采用 Cox 回归模型探讨血清 Lp-PLA2 水平与 MS 的相关性。对多因素分析结果进行数据处理，构建预测模型。
T2DM 患者 MS 发生率为 61.15%。MS 组患者血清 Lp-PLA2 水平显著高于非 MS 组（p<0.05）。血清 Lp-PLA2 与 FBG、糖化血红蛋白（HbA1c）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）呈显著正相关，与 LDL-C 呈显著负相关（p<0.05）。Lp-PLA2 预测 T2DM 患者 MS 的 ROC 曲线下面积为 0.724（95%CI：0.625-0.826，p<0.05）。当 Lp-PLA2 截断值为 82.96ng/mL 时，其预测 MS 的灵敏度、特异度、阳性预测值和阴性预测值分别为 73.7%、85.4%、77.56%和 93.24%。TC、TG、HDL-C、HbA1c 和 Lp-PLA2 是 MS 的独立危险因素（p<0.05）。基于上述指标建立的风险预测模型的 ROC 曲线下面积为 0.823，截断值、约登指数、灵敏度和特异度分别为 0.219、0.656、78.87%和 87.66%，提示该模型具有较高的预测价值。
血清 Lp-PLA2 水平升高是 T2DM 患者 MS 的独立危险因素，Lp-PLA2（82.87ng/mL）对 MS 具有较高的预测价值。
