Yang Hui-Hui, Dou Jie, Guo Ruo-Ling, Gao Jie, Li Hui-Zhe, Wang Kun, Hou Tian-Hua, Wei Tie-Jun, Guo Jing-Tao, Liu Jian-Wei, Luo Dong-Lei
Chengde Medical University, Chengde, People's Republic of China.
Department of Cardiology, Chengde Central Hospital/Second Clinical College of Chengde Medical University, Chengde, People's Republic of China.
Int J Gen Med. 2024 Oct 30;17:5015-5027. doi: 10.2147/IJGM.S485570. eCollection 2024.
The study aimed to explore the clinical diagnostic significance of lipoprotein(a) [Lp(a)] and neck circumference (NC) in patients with coronary heart disease (CHD).
This cross-sectional study was conducted at Chengde Central Hospital from September 2021 to June 2023, enrolling 791 patients with suspected CHD who underwent selective coronary angiography (CAG). Patients were categorized into CHD and non-CHD groups based on the severity of arterial narrowing. Subsequently, the diagnostic value of Lp(a) combined with NC in patients with CHD was assessed using receiver operating characteristic (ROC) curves. Based on the results of multivariate logistic regression, a nomogram was constructed, and its clinical applicability was validated using decision curve analysis (DCA) and clinical impact curve (CIC).
Multivariate logistic regression proved that high Lp(a) and high NC are risk factors for CHD, with OR of 1.836 (95% CI: 1.282-2.630) and 1.383 (1.0.978-1.955), respectively. Patients in the high NC or Lp(a) group exhibited a higher prevalence of multi-vessel disease. The area under the ROC curve (AUC) of the predictive model combining high Lp(a) and high NC was 0.710 (95% CI: 0.670-0.751) and also demonstrated good calibration (Hosmer-Lemeshow goodness-of-fit test value=0.494). The DCA and CIC confirmed the clinical utility of the nomogram developed to predict CHD based on the combination of high Lp(a) and high NC.
The levels of Lp(a) and NC exhibit a significant correlation with the presence of CHD, and their combined assessment holds specific clinical value in the diagnosis of CHD.
本研究旨在探讨脂蛋白(a)[Lp(a)]和颈围(NC)在冠心病(CHD)患者中的临床诊断意义。
本横断面研究于2021年9月至2023年6月在承德市中心医院进行，纳入791例接受选择性冠状动脉造影(CAG)的疑似CHD患者。根据动脉狭窄程度将患者分为CHD组和非CHD组。随后，使用受试者操作特征(ROC)曲线评估Lp(a)联合NC对CHD患者的诊断价值。基于多因素逻辑回归结果，构建列线图，并使用决策曲线分析(DCA)和临床影响曲线(CIC)验证其临床适用性。
多因素逻辑回归证明，高Lp(a)和高NC是CHD的危险因素，OR分别为1.836(95%CI：1.282 - 2.630)和1.383(1.0978 - 1.955)。高NC或Lp(a)组患者多支血管病变的患病率更高。高Lp(a)和高NC联合预测模型的ROC曲线下面积(AUC)为0.710(95%CI：0.670 - 0.751)，且校准良好(Hosmer-Lemeshow拟合优度检验值 = 0.494)。DCA和CIC证实了基于高Lp(a)和高NC联合开发的预测CHD列线图的临床实用性。
Lp(a)和NC水平与CHD的存在显著相关，联合评估在CHD诊断中具有特定的临床价值。
