原发性高血压伴颈动脉粥样硬化与脂蛋白相关磷脂酶A2活性水平相关性研究

Correlation between lipoprotein-associated phospholipase A2 level and carotid atherosclerosis in patients with essential hypertension

目的探讨原发性高血压（EH）患者伴发颈动脉粥样硬化（CAS）病变与脂蛋白相关磷脂酶A2（Lp－PLA2）的相关性。方法采用ELISA方法检测130例EH患者和50例健康人群（健康对照组）的血浆Lp-PLA2水平，根据颈动脉彩超检查结果，130例EH患者中伴发CAS者75例，其中无斑块18例，稳定斑块32例，不稳定斑块25例。结果EH伴发CAS者的Lp．PLA2中位数水平为（98～589）ng／ml，平均258ng／ml，明显高于单纯EH者[102（59～195）ng／ml]和健康对照组[68（10-153）ng／ml]，P〈0．01；血浆Lp．PLA2诊断EH伴发CAS的ROC曲线AUC为0．971，当以177．5ng／ml为临界值时，其敏感度、特异性、阳性预测值、阴性预测值和准确性分别为85．3％（64／75）、97．1％（102／105）、95．5％（64／67）、90．3％（102／113）、92．2％（166／180）。EH伴发CAS患者中无斑块组、稳定斑块组、不稳定斑块组Lp—PLA2水平分别平均为169ng／ml、249ng／ml、372ng／ml，三组间差异有统计学意义。结论Lp—PLA2检测对EH患者早期CAS有预测意义，为CAS早期诊断和干预治疗提供积极的参考价值。

Objective To study the correlation of lipoprotein associated phospholipase A2 （Lp-PLA2） with carotid atherosclerosis （CAS） in patients with essential hypertension （EH）. Methods The levels of Lp-PLA2 were measured by ELISA in 130 patients ofEH （EH group） and 50 healthy subjects （healthy control group）. According to the results of cervical vascular color Doppler ultrasound examination, there were 75 patients with CAS in 130 patients with EH, and were classified into non-plaque group （18 cases）, stable plaque group （32 cases） and unstable plaque group （25 cases）. Results The median value of Lp-PLA2 was higher in EH patients with CAS [258 （98-589） ng/ml]than that in EH patients [102 （59-195） ng/ml] and in control subjects [68 （10-153） ng/ml] （P〈0.01）. The area under the ROC curve （AUC） was 0.971. When cutoff value of the Lp-PLA2 was 177.5 ng/ml, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate were 85.3% （64/75）, 97.1% （102/105）, 95.5% （64/67）, 90.3% （102/113）, 92.2% （166/180）. The median value of Lp-PLA2 were 169 （98-265） ng/ml, 249 （145-364） ng/ml, 372 （259-589） in EH patients with CAS in non-plaque group, stable plaque group and unstable plaue group, respectively. There was statistically significant difference among the three groups. Conclusion Lp-PLA2 detection has significance for prediction of early CAS in patients with EH, and can provide a positive reference value for early diagnosis and intervention of CAS.