冠心病患者血液脂蛋白相关磷脂酶A2与超敏C反应蛋白及D-二聚体的相关性研究

The correlationship of plasma lipoprotein-associated phospholipase A2, hypersensitive C-reactive protein and D-dimer in coronary artery disease patients

目的 探讨冠状动脉粥样硬化性心脏病（冠心病）患者脂蛋白相关的磷脂酶A2酶活性（lipoprotein associated phospholipase A2,Lp-PLA2）、超敏C反应蛋白（hypersensitive C reactive protein,hs-CRP）、D-二聚体之间的相关性及其临床应用价值.方法 采用病例对照研究,选择北京大学人民医院冠心病患者150例,健康对照者130名,采集临床资料,检测血清Lp-PLA2、hs-CRP及血浆D-二聚体水平.应用酶动力学方法检测Lp-PLA2的酶活性,免疫比浊法测定D-二聚体及hs-CRP含量.同时检测低密度脂蛋白胆固醇（LDL-c）及心肌损伤标志物肌钙蛋白（TnI）、肌红蛋白（Myo）、肌酸激酶MB亚型（CK MB）.患者组由经皮冠状动脉介入术（PCI）确认累及冠状动脉的病变血管数量.统计学分析采用t检验、方差分析、mann-whitney U检验及Spearman相关分析.结果 冠心病组Lp-PLA2、hs-CRP、D-二聚体水平分别为（43.62±13.23）g/L,5.09 mg/L（95％ CI：0.56 ～74.15）,173.0 mg/L（95％CI：103.0～966.5）,均明显高于健康对照组的（21.49±7.63） g/L,2.61 mg/L（95％ CI：0.37～45.12）,68.0mg/L（95％CI：48.0～540.6）,差异有统计学意义（t=2.69,U=67.52,U=37.84,P均＜0.001）.冠心病组的Lp-PLA2与LDL相关（r=0.487,P＜0.001）,与心脏冠状动脉病变支数相关（r =0.260,P=0.018）.D-二聚体与hs-CRP相关（r=0.263,P=0.011）,且与心功能等级相关（F=23.78,P=0.001）.结论 Lp-PLA2主要和脂类的代谢,特别是LDL代谢相关,与冠状动脉病变程度相关.hs-CRP与D-二聚体及心肌损伤标志物相关,表明炎症和血栓形成及心肌损伤存在密切关系.D-二聚体和心功能等级相关,心功能的降低更易于D-二聚体升高及血栓形成.对于冠心病患者,Lp-PLA2、hs-CRP与D-二聚体与冠脉损伤直接相关,它们是良好的临床预后指标.

Objective To study the correlationship among plasma lipoprotein associated phospholipase A2 （Lp-PLA2）,hypersensitive C reactive protein （hs-CRP） and D-dimer levels of coronary heart disease （CHD） patients.To evaluate their relationship and prognostic values.Methods Case control study.This study enrolled 150 CHD patients,130 age and gender compared health control.The clinical data were recorded and plasma Lp-PLA2,hs-CRP and D-dimer were test.Lp-PLA2 was test by enzyme kinetics method,hs-CRP and D-dimer were test by immunonephelometry method.The blood were also test low density lipoprotein cholesterol and myocardial injury markers such as troponin I,myoglobin,creatin kinase MB.The numbers of lesion coronary arteries were confirmed by percutaneous coronary intervention operation.Student t-test and mann-whitney U test were used to compare two groups datas,analysis of variance was used to compare more than three groups datas,spearman test was used for correlationship analysis between groups.Results The Lp-PLA2,hs-CRP and Ddimer of CHD group were （43.62 ±13.23） g/L,5.09 mg/L（95% CI：0.56-74.15）,173.0 mg/L（95% CI：103.0-966.5）,respectively.They were higher than healthy control group whose values were （21.49 ± 7.63）g/L,2.61 mg/L（95 % CI：0.37-45.12）,68.0 mg/L （95% CI：48.0-540.6）,respectively.The difference were statistical significant （t =2.69,U =67.52,U =37.84,P 〈 0.001）.After correlation with clinical data,the Lp-PLA2 was correlated to LDL（r =0.487,P 〈 0.001） and the numbers of coronary artery lesion （r =0.260,P =0.018）.D-dimer was correlated to hs-CRP（r =0.263,P =0.011）,it was also correlated to NYHA heart function level （F =23.78,P =0.001）.Conclusions Lp-PLA2 is important in lipid metabolize,especially in LDL metabolize.Lp-PLAz can be used to predict severity of coronary artery lesion.Hs-CRP correlated to D-dimer level and cardiac injury markers.It stated link between inflammation and thrombosis.D-dimer is increasing with NYHA level.Lp-PLA2,hs-CRP and D-dimer are correlated to coronary artery lesions,they are good prognostic indices for coronary heart disease patients.