急性冠状动脉综合征早期脂蛋白相关磷脂酶A_2水平研究

Level of lipoprotein-associated phospholipase A_2 in the early stage of acute coronary syndrome

目的探讨脂蛋白相关磷脂酶A2（1ipoprotein-associated phospholipase A2，Lp—PLA2）在急性冠状动脉综合征（acute coronary syndrome，ACS）早期诊断及严重程度评估中的临床意义。方法76例经冠状动脉造影确诊的ACS患者（ACS组），其中不稳定性心绞痛患者42例（uAP组）、急性心肌梗死患者34例（AMI组）；同期体检健康者36例（对照组）。检测各组Lp—PLA2、肌酸激酶同工酶、肌红蛋白及肌钙蛋白T水平，采用ROC曲线分析正常人群与ACS最适界值点。结果AMI组和UAP组血清Lp—PLA2、肌酸激酶同工酶、肌红蛋白及肌钙蛋白T水平明显高于对照组（P〈0．05），AMI组高于UAP组（P〈O．05）；Lp—PLA2的AUC为0．940时诊断ACS的敏感性为90．8％，特异性为91．7％；Gensini积分〉40分者血清Lp—PLA2水平明显高于〉20～40分者与0～20分者（P〈0．05），冠状动脉3支病变者血清Lp—PLA2水平明显高于双支病变者和单支病变者（P〈O．05）。结论Lp—PLA2在ACS早期诊断中敏感性和特异性均较高，且与ACS患者冠状动脉病变严重程度有关。

Objective To investigate the clinical significance of serum lipoprotein-associated phospholipase A2 （Lp-PLA2） in the early diagnosis and the evaluation of the severity of acute coronary syndrome （ACS）. Methods Seventy-six patients with angiographically confirmed ACS included 42 patients with unstable angina pectoris （UAP） and 34 patients with acute myocardial infarction （AMI）. Another 36 healthy volunteers were as controls. The level of creatine kinase isoenzyme MB （CK-MB）, cardiac troponin T （cTnT）, myoglobin （Myo） and Lp-PLA2 were detected in all groups. ROC curve analysis was used to determined the optimal cutoff for identifying normal individuals in ACS patients. Results The levels of Lp-PLA2 , CK-MB, Myo and cTnT were higher in ACS patients than those in control group （P〈0.05）, and higher in AMI patients than those in UAP patients （P〈0.05）. When the AUC of Lp-PLA2 was 0. 940, the sensitivity for ACS was 90. 8%, and the specificity was 91. 7%. The Lp-PLA2 level was significantly higher in patients with Gensini scores 〉40 than that in patients with Gensini scores from 20 to 40 and from 0 to 20, and was higher in patients with triple-vessle lesion than that in patients with double-vessle and single-vessle lesion （P〈0.05）. Conclusions Lp-PLA2 has high sensitivity and specificity for the early diagnosis of ACS and is correlated with the severity of coronary artery disease.