脂蛋白(a)和冠脉周围脂肪衰减指数在冠心病风险评估中的价值OA

Objective To investigate the value of lipoprotein(a)[Lp(a)]and coronary perivascular fat attenuation index(FAI)in risk assessment of coronary heart disease(CHD).Methods A retrospective study was conducted to collect clinical data from 81 CHD patients diagnosed by coronary CT angiography and 125 normal controls from Wenshan Prefecture People's Hospital between October 2021 and January 2023.Clinical information,Lp(a)results,plaque characteristics,the number of lesion vessels,calcification scores,Gensini scores,and FAI values related to the anterior segments and lesion segments of the left anterior descending artery(LAD),left circumflex artery(LCx),and right coronary artery(RCA)were gathered from all subjects.Differences in Lp(a),calcification score,Gensini score,and FAI between CHD and control groups as well as among different CHD vessel groups were analyzed.Comparisons were made between plaques of different characteristics and FAI values.Logistic regression analysis was used to identify risk factors for CHD and the interactive effects of Lp(a)and FAI on CHD risk.Pearson correlation analysis was performed to assess the correlation between Log-Lp(a)and FAI.ROC curves were used to evaluate the diagnostic value of Lp(a)and FAI for CHD,with DeLong test to compare differences in AUC values.Results Lp(a)levels and mean FAI values of the proximal segments of the three coronary arteries showed statistically significant differences between CHD and control groups(P<0.05 for all).Lp(a)concentration was positively correlated with calcification score(r=0.385,P<0.001).With increasing number of affected vessels in the CHD group,calcification score and Gensini score progressively increased(P<0.05 for all).Lp(a)and FAI of the proximal three coronary arteries showed statistically significant differences only between single-vessel and multi-vessel disease groups(P<0.05).Lesion segment FAI showed statistically significant differences only between non-calcified and calcified plaques(P<0.05).Multivariate logistic regression showed Log-Lp(a)and FAI as independent risk factors for CHD,with weak correlation between FAI and Log-Lp(a)(r=0.352,P<0.001).ROC curve analysis revealed AUC values of 0.729,0.856,and 0.879 for Lp(a),FAI,and their combination respectively for CHD diagnosis.DeLong test demonstrated that FAI and their combination had significantly larger AUC values than Lp(a)(P<0.05 for all).Interaction analysis showed that the interactive OR value for high Lp(a)and high FAI was 78.111(95%CI:20.778～293.645,P<0.001),indicating synergistic effects in increasing CHD risk.Conclusion Lp(a)and FAI are independent risk factors for CHD with synergistic amplification effects,and can serve as effective indicators for CHD prevention and risk stratification.