脂蛋白相关磷脂酶A_2及血小板活化因子与急性冠脉综合征临床研究

Clinical significance of level changes in lipoprotein-associated phospholipase A_2 and platelet activating factor in acute coronary syndrome

目的探讨急性冠脉综合征患者血浆脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A,Lp-PLA2)和血小板活化因子(platelet activating factor,PAF)浓度变化及其临床意义。方法选择经冠状动脉造影检查的260例心内科住院患者,按照临床表现及造影结果分组:急性冠脉综合征组115例,包括不稳定型心绞痛亚组70例、急性心肌梗死亚组45例;非急性冠脉综合征冠状动脉粥样硬化性心脏病(冠心病)组94例,包括稳定型心绞痛亚组56例、冠状动脉慢性完全闭塞亚组38例;正常冠状动脉对照组51例。采用夹心酶联免疫吸附法检血浆Lp-PLA2及PAF浓度。结果与对照组比较,急性冠脉综合征及非急性冠脉综合征患者血浆Lp-PLA2[(89.05±25.01)μg/L vs.(11.85±4.17)μg/L,P<0.001;(19.86±9.91)μg/L vs.(11.85±4.17)μg/L,P<0.01]及PAF[(139.44±56.49)μg/L vs.(58.67±12.46)μg/L,P<0.001;(64.36±13.89)μg/L vs.(58.67±12.46)μg/L,P<0.05]浓度显著升高,差异均有统计学意义。与对照组比较,亚组中,除稳定型心绞痛亚组血浆Lp-PLA2及PAF浓度无明显升高外(P>0.05),其余亚组包括不稳定型心绞痛、急性心肌梗死、冠状动脉慢性完全闭塞亚组的Lp-PLA2及PAF浓度均显著升高,差异有统计学意义(均P<0.01)。结论血浆Lp-PLA2及PAF浓度在急性冠脉综合征患者明显增高,可能提示粥样斑块不稳定性,有可能成为急性冠脉综合征的新的干预靶点。

Objectives To examine level changes in plasma lipoprotein-associated phospholipase A2 （Lp-PLA2） and platelet activating factor （PAF）, and to evaluate their clinical value in acute coronary syndrome （ACS）. Methods A total of 260 hospitalized patients undergoing coronary angiography were selected and divided into following groups according to coronary angiography results and clinical characteristics： ACS group （115 cases）, non-ACS group （94 cases） and control group with normal coronary arteries （NCA, 51 cases）. ACS group included unstable angina pectoris subgroup （UAP, 70 cases） and acute myocardial infarction subgroup （AMI, 45 cases）; non-ACS group included stable angina pectoris subgroup （SAP, 56 cases） and chronic total occlusion subgroup （CTO, 38 cases）. Plasma levels of Lp-PLA2 and PAF in all individuals were determined by enzyme linked immunosorbent assay （ELISA）. Results Compared with control group, plasma levels of Lp-PLA2 in ACS group [ （89.05 ±25.01 ） μg/L vs. （11.85±4.17） μg/L, P〈0.001 ] and non- ACS group [（ 19.86±9.91 ） μg/L vs. （11.85±4.17） μg/L, P〈0.01 ] as well as plasma levels of PAF in ACS group [（139.44±56.49） μg/Lvs. （58.67±12.46） μg/L,P〈0.001] and non-ACS group （64.36_＋13.89） μg/Lvs. （58.67_＋ 12.46） μg/L, P〈0.05 ] were significantly increased. Except SAP subgroup （P〉0.05）, Lp-PLA2 and PAF plasma levels in all subgroups including AMI, UAP, and CTO subgroups were elevated obviously （P〈0.01） when comparing with those in control group. Conclusions Plasma levels of Lp-PLA2 and PAF increase significantly in ACS patients, which can he a diagnostic predictor and novel treated target for unstable atherosclerotie olaclue.