ⅡA分泌型磷脂酶A2与冠心病的关系

Correlation of group ⅡA secretory phospholipase A2 and coronary heart disease

目的 测定冠心病患者及非冠心病患者体内ⅡA分泌型磷脂酶A2（ⅡA-sPLA2）的浓度；分析它与高敏C-反应蛋白（hs-CRP）之间的相关性。方法 40例确诊冠心病患者及46例非冠心病患者对照，采用酶免法测定EDTA抗凝血浆中的ⅡA-sPLA2浓度；采用免疫比浊法测定血清中hs-CRP含量；同时，应用酶法测定血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白的浓度。结果 冠心病患者ⅡA-sPLA2浓度的中位数（242．5ng／d1）显著高于非冠心病组的浓度中位数（198．7ng／d1）（P〈0．05）；ⅡA-sPLA2与hs-CRP呈显著正相关（P〈0．05），与传统的危险因子（年龄、吸烟、糖尿病、高血压、高胆固醇血症、低HDL-C）无相关性。多变量Logistic回归分析显示：高浓度ⅡA-sPLA2（333．9ng／d1，非冠心病组90％分布）、吸烟、糖尿病是区分冠心病与非冠心病显著的变量。结论 体内高浓度的ⅡA-sPLA2是冠心病重要的危险因子，它可能与发生动脉粥样硬化时炎症的活化有关。

Objective To measure the concentration of the group ⅡA secretory phospholipase A2 （ ⅡA-sPLA2） and to analyze its correlation with high-sensitive C-reactive protein （hs-CRP） in patients with coronary heart disease （CHD） and non-CHD. Methods Forty patients with CHD and forty-six control subjects with non-CHD were recruited from inpatient clinics. The concentration of the ⅡA-sPLA2 in EDTA-plasma and serum hs-CRP were examined respectively by enzymoimmunoassay and latex-enhanced immunoturbidimetric assay. At the same time, concentrations of serum total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol and Glu were determined by corresponding enzymatic methods. Results The medium of ⅡA-sPLA2 in patients with CHD was 242. 5 （ 168. 8- 443.5）ng/d1, which was significantly higher than that in patients with non-CHD[198. 7（144. 2-276. 9） ng/d1] （P〈0.05）. There was a significant positive correlation between ⅡA-sPLA2 level and that of high-sensitive C-reactive protein. There was no significant correlation of higher ⅡA-sPLA2 level with each of the traditional coronary risk factors （age〉70 years, smoking history, diabetes mellitus, hypertension, hypercholesterolemia, and low HDL-cholesterol）. Multivariate logistic regression analysis showed that higher level of ⅡA-sPLA2 （〉333.9 ng/d1; 90% of ⅡA-sPLA2 distribution in patients with non-CHD）, smoking history, diabetes mellitus were the variables differencing CHD and non- CHD. Conclusion High level of ⅡA-sPLA2 in the circulation is an important risk factor of CHD, and it is associated with inflammatory activity in atherosclerotic arteries.