脂蛋白相关磷脂酶A_2对急性心肌梗死预后的预测价值

Prognostic value of lipoprotein-associated phospholipase A_2 concentrations in patients with acute myocardial infarction

目的:探讨脂蛋白相关磷脂A2(Lp-PLA2)对急性心肌梗死(AMI)预后的预测价值。方法:连续入选经冠脉造影的住院者,分为AMI组74例和非冠心病组28例。ELISA测定血浆Lp-PLA2。随访1年,观察心血管事件发生情况。结果:AMI患者Lp-PLA2水平高于非冠心病者(P<0.01)。发生心血管事件者Lp-PLA2水平高于未发生者(P<0.05);Lp-PLA2水平高的四分位间距,事件发生率明显增加(P<0.01)。当Lp-PLA2≥276ng/ml对AMI预后判定的ROC曲线下面积为0.755,阳性预测值为81.6%、阴性预测值为62.5%。Kaplan-Meier生存分析提示Lp-PLA2≥276ng/ml的生存率明显小于Lp-PLA2<276ng/ml的生存率(Logrank检验P=0.012)。Cox模型逐步回归分析,Lp-PLA2水平≥276 ng/ml为1年内AMI者死亡的独立预测因子。结论:高水平Lp-PLA2对AMI患者1年内发生心血管事件的预测有一定的价值。

Objective： To elucidate the combination with lipoprotein-associated phospholipase A2（Lp-PLA2） and outcomes in patients with acute myocardial infarction（AMI）.Methods： One hundred and two consecutive individuals underwent coronary angiography were categorized into two groups： AMI and no-coronary heart disease. Plasma samples were collected for measurement of Lp-PLA2 by enzyme-linked immunosorbent assay,other biochemical markers and parameters were simultaneously measured.During following-up for one year,the following cardiovascular events were reached by regular visits： death,re-myocardial infarction,angina pectoris after myocardial-infarction,decompensated heart failure,life threatening arrhythmias,coronary revascularization.Results： Lp-PLA2 levels were higher in AMI compared with control subjects（261±74ng/mL vs 215±28ng/mL,P=0.01）,clinical characteristics at baseline were similar in both groups（P0.05）.During following-up,26 cardiovascular events occurred in contacted patients.Levels of Lp-PLA2 were apparently different in patients who experienced an event as compared with that in event-free subjects（254±24ng/ml vs 276±34ng/ml,P=0.002）.In addition,over a quartile range of increasing Lp-PLA2 there was a significant increasing in incidence of events（P=0.000）.At a cut-off the fourth quartile of Lp-PLA2 counts（276ng/ml） in determining the predictive power for prognosis,area under ROC was 0.755,positive predictive value 81.6%,negative predictive value 62.5%.By Kaplan-Meier method,the survival rates of Lp-PLA2 count≥276ng/ml and 276ng/ml were significantly different（P=0.013）.Cox regression model analysis demonstrated Lp-PLA2 count≥276ng/ml was a powerful independent predictor.Conclusion： Advanced concentrations of Lp-PLA2 appear to be prognostic value within one year for cardiovascular events in patients with AMI.