2025 年第 3 期 第 20 卷

老年心力衰竭患者沙库巴曲缬沙坦治疗后血清脂蛋白相关磷脂酶A2水平对心室重塑的预测价值

Predictive value of serum lipoprotein-associated phospholipase A2 level for ventricular remodeling in elderly patients with heart failure after sacubitril/valsartan treatment

作者：殷宇岗李瑶杨春吕磊

英文作者：Yin Yugang Li Yao Yang Chun Lyu Lei

单位：东部战区总医院干部二科心脏病区，南京210000

英文单位：Cardiology Ward Second Department of Cadre Eastern Theater General Hospital Nanjing 210000 China

关键词：心力衰竭；沙库巴曲缬沙坦；脂蛋白相关磷脂酶A2；心室重塑

英文关键词：Heartfailure;Sacubitril/valsartan;Lipoprotein-associatedphospholipaseA2;Ventricularremodeling

• 摘要：

• 目的 探究老年心力衰竭患者沙库巴曲缬沙坦治疗后血清脂蛋白相关磷脂酶A2（Lp-PLA2）水平对心室重塑的预测价值。方法 选取2021年1月至2023年12月东部战区总医院收治的102例经沙库巴曲缬沙坦治疗的心力衰竭患者作为研究对象。根据治疗后是否发生心室重塑将患者分为发生组（34例）和未发生组（68例）。比较2组临床资料以及心电学指标。排除存在共线性的混杂因素，分析各因素与心室重塑的独立相关性。构建发生心室重塑的风险预测模型并评价。多元线性回归方法分析Lp-PLA2与心率变异性的关系。分层回归分析Lp-PLA2与心室重塑在不同临床指标方面的关系。限制性立方样条法分析Lp-PLA2与心室重塑的剂量反应关系。结果 逐步排除存在共线性的混杂因素，发现较高水平N末端B型脑钠肽前体、肿瘤坏死因子α、可溶性致癌抑制因子2、高敏C反应蛋白、Lp-PLA2、转化生长因子β、基质金属蛋白酶9、Ⅰ型前胶原羧基端肽与低水平R-R间期标准差与心室重塑存在独立相关性（均P＜0.05）。构建发生心室重塑的风险预测模型，强影响点（Cook距离均＜1）和受试者工作特征曲线分析结果显示模型预测效果良好（曲线下面积为0.895）。多元线性回归分析结果显示，Lp-PLA2是预测心率变异性降低的独立危险因素（β=-0.237,95%置信区间：-0.468～-0.127，P=0.031）。分层分析结果显示，Lp-PLA2与心室重塑在不同性别、年龄、体重指数、病程、病因、纽约心脏病协会心功能分级亚组中的关联差异均有统计学意义（均P＜0.05）。限制性立方样条结果显示，Lp-PLA2与心室重塑的关联强度呈非线性剂量反应关系（P＜0.05），大致呈显著正相关。结论 Lp-PLA2是心室重塑发生的独立危险因素，临床可据此有效预测心力衰竭患者治疗后心室重塑的发生。

• Objective  To investigate the predictive value of serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level for ventricular remodeling in elderly patients with heart failure (HF) after sacubitril/valsartan treatment. Methods A total of 102 patients with HF treated with sacubitril/valsartan in Eastern Theater General Hospital from January 2021 to December 2023 were selected as the research objects. According to the presence or absence of ventricular remodeling after treatment, the patients were divided into the occurrence group (34 cases) and the non-occurrence group (68 cases). The clinical data and electrocardiographic parameters were compared between the two groups. Excluding the confounding factors of collinearity, the independent correlation between each factor and ventricular remodeling was analyzed. The risk prediction model of ventricular remodeling was constructed and evaluated. The relationship between Lp-PLA2 and heart rate variability was analyzed by multiple linear regression. Hierarchical regression analysis was used to analyze the relationship between Lp-PLA2 and clinical parameters of ventricular remodeling. The dose-response relationship between Lp-PLA2 and ventricular remodeling was analyzed by restricted cubic spline. Results The confounding factors of collinearity were gradually excluded. Higher levels of N-terminal pro-brain natriuretic peptide, tumor necrosis factor-α, soluble suppression of tumorigenicity 2, high-sensitivity C-reactive protein, Lp-PLA2, transforming growth factor-β, matrix metalloproteinase 9, and carboxy-terminal peptide of type Ⅰ procollagen were found to be independently correlated with ventricular remodeling, as well as lower levels of standard deviation of R-R interval (all P<0.05). The risk prediction model of ventricular remodeling was constructed, and the results  of strong influence points(Cook distance<1) and receiver operating characteristic curve analysis showed that the model had good prediction effect (area under the curve was 0.895). Multivariate linear regression analysis showed that Lp-PLA2 was an independent risk factor for predicting the reduction of heart rate variability(β=-0.237,95%confidence interval:-0.468 to -0.127，P=0.031). The results  of stratified analysis showed that Lp-PLA2 was significantly associated with ventricular remodeling in subgroups with different gender, age, body mass index, disease duration, etiology, and New York Heart Association cardiac function classification(all P<0.05). The results  of restricted cubic spline showed a non-linear dose-response relationship between Lp-PLA2 and ventricular remodeling(P<0.05), and there were roughly significant positive correlations. Conclusion Lp-PLA2 is an independent risk factor for ventricular remodeling, which can effectively predict the occurrence of ventricular remodeling in patients with HF after treatment.