目的：研究脂蛋白a以及ApoE基因多态性与心脏瓣膜钙化的相关性,探讨基因型和脂蛋白a在疾病进程中的作用。方法：选取2021年7月至2022年12月心内科收治住院的患者412例。收集患者脂蛋白a及其他血脂结果、ApoE基因型、超声心动图、颈动脉内膜中层厚度(IMT),并记录入组者血压等临床资料,同时记录心律失常、心力衰竭、心脏瓣膜病史、ACS的病史,分析ApoE基因型与血脂和心脏瓣膜钙化三者之间的相关性。结果：三组基线资料中TC、 TG、脂蛋白a、LDL-C 含量具有统计学差异;与ε3组比较,ε2组脂蛋白a和LDL-C含量较低,而ε4组的含量较高;单因素分析中年龄、HDL-C、TG、脂蛋白a、LDL-C、IMT、心律失常病史、心力衰竭病史、心脏瓣膜病病史与瓣膜钙化相关;二元logistic回归分析显示,年龄、脂蛋白a、IMT、心律失常病史是心脏瓣膜钙化的独立危险因素;在ε2、ε3亚组中脂蛋白a与心脏瓣膜钙化具有相关性,在ε4中相关性不存在。IMT和脂蛋白a联合诊断预测心脏瓣膜钙化的曲线下面积是0.760(P＜0.001)。结论：ApoE基因型不直接对钙化的发生造成影响,而是通过改变血脂间接影响疾病。ε4可能和脂蛋白a、LDL-C升高有关;ε2可能和脂蛋白a、LDL-C降低有关。脂蛋白a可能和LDL-C的含量具有相关性。
Objective: To study the correlation between lipoprotein a, ApoE gene polymorphism and cardiac valve calcification, and to explore the role of genotype and lipoprotein a in the disease process. Methods: A total of 412 patients admitted to the Department of Cardiology from July 2021 to December 2022 were selected. The results of lipoprotein a and other blood lipids, ApoE genotype, echocardiography and carotid intima-media thickness (IMT) were collected, and the clinical data such as blood pressure were recorded. At the same time, the history of arrhythmia, heart failure, valvular heart disease and ACS were recorded. The correlation between ApoE genotype and blood lipid, cardiac valve calcification was analyzed. Results: The contents of TC, TG, lipoprotein a and LDL-C in the baseline data of the three groups were statistically different. Compared with the ε3 group, the contents of lipoprotein a and LDL-C in the ε2 group were lower, while those in the ε4 group were higher. Univariate analysis showed that age, HDL-C, TG, lipoprotein a, LDL-C, IMT, history of arrhythmia, history of heart failure, history of valvular heart disease were associated with valvular calcification. Binary logistic regression analysis showed that age, lipoprotein a, IMT and history of arrhythmia were independent risk factors for cardiac valve calcification. There was a correlation between lipoprotein a and cardiac valve calcification in the ε2 and ε3 subgroups, but there was no correlation in ε4 subgroup. The area under the curve for the combined diagnosis of IMT and lipoprotein a to predict cardiac valve calcification was 0.760 (P＜0.001). Conclusion: ApoE genotype does not directly affect the occurrence of calcification, but indirectly affects the disease by changing blood lipids. ε4 may be related to the increase of lipoprotein a and LDL-C. ε2 may be related to the decrease of lipoprotein a and LDL-C. Lipoprotein a may be related to the content of LDL-C.
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