冠心病脂蛋白相关磷脂酶A2水平与冠脉病变的相关性研究

Study on Relationship between Plasma Lipoprotein-Associated Phospholipase A2 and Coronary Atherosclerosis in Coronary Heart Disease

目的:探讨冠心病患者血脂蛋白相关磷脂酶A2(Lp-PLA2)水平与冠状动脉病变程度及斑块稳定性的关系。方法:将299例拟诊冠心病患者根据冠脉造影结果分为冠心病组(232例)和对照组(67例),冠心病患者再根据临床类型分为急性心肌梗死(AMI)组(46例)、不稳定型心绞痛(UAP)组(114例)和稳定型心绞痛(SAP)组(72例)并计算冠脉Gensini积分,检测其血浆Lp-PLA2水平及总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、脂蛋白a[Lp(a)]、纤维蛋白原(FIB)和C反应蛋白(CRP)水平并进行比较,分析Lp-PLA2与冠心病及Gensini积分的关系。结果:冠心病组血浆Lp-PLA2水平高于对照组(P<0.01);AMI组和UAP组患者Lp-PLA2水平高于SAP组(P<0.05),AMI组和UAP组之间差异无统计学意义;Lp-PLA2水平与LDL-C、CRP、Gensini积分呈正相关,Lp-PLA2、高血压、LDL-C和Lp(a)是冠心病的独立危险因素,HDL-C为保护因素,Gensini积分受年龄、Lp-PLA2、HDL-C和LDL-C的影响。结论:血Lp-PLA2升高是冠心病的独立危险因素之一,Lp-PLA2水平与冠脉病变严重程度及动脉粥样硬化斑块的稳定性相关。

Objective：To investigate whether plasma lipoprotein-associated phospholipase A2（Lp-PLA2） activity was correlated with severity and stability of coronary atherosclerosis in coronary heart disease（CHD）.Methods：Coronary angiography（CAG） was performed in 299 patients suspected as having CHD.According to the result of CAG,patients were divided into CHD group（n=232） and control group（n=67）.The CHD group was further divided into subgroups according to the clinical types,including acute myocardial infarction group（AMI,n=46）,unstable angina group（UAP,n=114） and stable angina pectoris group（SAP,n=72）.The Gensini score was calculated.The plasma levels of Lp-PLA2,total cholesterol（TC）,triglyceride（TG）,low density lipoprotein-cholesterol（LDL-C）,high density lipoprotein-cholesterol（HDL-C）,lipoprotien-a Lp（a）,fibrinogen（FIB） and C-reactive protein（CRP） were measured in all groups and the results were compared and analyzed.Results：The plasma level of Lp-PLA2 activity was higher in CHD group than that in control group（P 0.01）.There was no significant difference in the level of Lp-PLA2 between AMI and UAP group.The plasma level of Lp-PLA2 was positively correlated with LDL-C,CRP and Gensini score.The Level of Lp-PLA2,hypertension,LDL-C and Lp（a）were independent risk factors of CHD.The level of HDL-C was a protective factor of CHD,while Gensini score was affected by age,Lp-PLA2,HDL-C and LDL-C.Conclusion：Lp-PLA2 is one of independent risk factors of CHD.The plasma level of Lp-PLA2 is related to the degree of coronary artery stenosis and the stability of coronary atherosclerosis.