目的：探讨溶血磷脂酸（ LPA）对于不稳定型心绞痛（ UA）患者预后判断的临床意义。方法2012年1月—2014年1月心血管内科收治新发UA患者69例，记录患者病史资料并进行相关实验室检查。 UA患者出院后均进行为期6个月的常规随访。随访期间转归为非ST段抬高型心肌梗死（NSTEMI）患者作为NSTEMI组（29例），未发生不良转归患者为UA组（40例）。比较2组患者入院时各项危险因素的差异性，并使用logistic回归分析进一步提取独立危险因素，绘制相应指标的ROC曲线，计算曲线下面积（ AUC）及约登指数（ YI）。结果与UA组相比，NSTE-MI组患者的LPA、平均动脉压（ MAP）、心肺梗死试验危险评分（ TIMI）、血小板（ PLT）、三酰甘油（ TG）、低密度脂蛋白（LDL-C）、糖化血红蛋白（HbA1c）、纤维蛋白原（Fib）、心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）、肌红蛋白（MYO）等11项危险因素存在显著差异（ P ＜0«．05），经多因素Logistic回归分析得出TIMI、LDL-C、HbAlc、LPA等4项指标是UA预后转归为NSTEMI的独立危险因素。其中LPA判定UA不良预后的AUC为0．730，其余3项指标联合判定UA不良预后的AUC为0．879，加入LPA后AUC增加至0．888。结论 LPA水平可作为评判UA预后的独立敏感因素，其含量变化与UA患者6个月内进展至NSTEMI相关，将LPA纳入UA的诊疗体系以用于临床干预具有重要意义。%Objective To investigate the significance of lysophosphatidic acid ( LPA) in predicting prognosis of pa-tient with unstable angina pectoris (UA).Methods From 2012 January to 2014 January,69 patients in department of cardio-logy with new onset of UA were enrolled;history data of the patients and related laboratory examination were recorded .After discharge from hospital , UA patients were routine follow-up of 6 months .During the follow up , non ST segment elevation myo-cardial infarction (NSTEMI) patients were enrolled as NSTEMI group (29 cases), no adverse outcome patients as UA group (40 cases).Differences of various risk factors during admission were compared between the 2 groups, and use logistic regres-sion analysis to further extract the independent risk factors , ROC curve of the corresponding index were illustrated , area under the curve (AUC) and Youden index (YI) were calculated.Results Compared with UA group, patients in the NSTEMI group’s LPA, mean arterial pressure (MAP), heart and lung infarction risk test score (TIMI),platelet(PLT),three glycerol (TG), low density lipoprotein (LDL-C), glycosylated hemoglobin (HbA1c), fibrinogen (Fib), cardiac troponin I (cTNI), creatine kinase isoenzyme (CK-MB), myoglobin (MYO), LPA and other 11 risk factors were significant different (P <0.05), multivariate Logistic regression analysis showed that TIMI , LDL-C, HbA1c, LPA were independent risk factors for UA changed to NSTEMI.The AUC of LPA to predict UA poor prognosis was 0.730, the AUC of remaining 3 indicators combina-tion to predict the poor prognosis of UA was 0.879,AUC increased to 08.88 after combined with LPA.Conclusion LPA levels can be used as independent sensitive factor to predict the prognosis of UA , the content changes of it is related to UA patients recent 6 months of progression to NSTEMI , LPA included into the UA diagnosis system has important significance for clinical treatment.
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