脂蛋白相关磷脂酶A2检测在老年心脑血管疾病防治中的临床意义

Clinical significance of Lp-PLA2 in prevention of cardiovascular and cerebrovascular diseases in elderly people

目的:探讨脂蛋白相关磷脂酶A2(Lp-PLA2)检测在老年心脑血管病防治的意义。方法:选取老年体检人群185例,收集资料包括血脂、血糖等生化指标,病史及一二级预防用药情况,采用酶联免疫吸附法(ELISA)检测血浆Lp-PLA2水平,6个月后电话随访有无确诊的心脑血管疾病事件发生情况。结果:血浆Lp-PLA2水平与总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平呈正相关,其相关系数分别为0.219(P=0.003)和0.185(P=0.012);与口服降脂药呈负相关,相关系数为-0.153(P=0.038)。随访6个月共有新发心脑血管疾病患者10例(6.7%),其中冠心病8例(5.3%),短暂性脑缺血发作1例(0.67%),脑梗死1例(0.67%)。Logistic回归模型显示,Lp-PLA2异常是唯一对心脑血管发生有影响的重要危险因素(P=0.046)。结论:Lp-PLA2异常与心脑血管疾病发生密切相关,在老年体检中开展Lp-PLA2检测有利于发现高危人群,对有效防治心脑血管疾病有重要意义。

Objective： To study the significance of the lipoprotein associated phospholipase A2（ Lp-PLA2） in the prevention of cardiovascular and cerebrovascular diseases in elderly people. Methods： 185 elderly people were selected. The physical examination data such as blood lipid,blood glucose,medical history and both primary and secondary prevention medication were collected,and the plasma Lp-PLA2 level was determined with enzyme-linked immunosorbent assay（ ELISA）. After 6 months,the telephone follow-up was made to reveal the incidence of diagnosed cardiovascular and cerebrovascular diseases. Results： There was a positive correlation between plasma Lp-PLA2 level and total cholesterol（ TC）,low density lipoprotein cholesterol（ LDL-C）,the correlation coefficient being 0. 219（ P = 0. 003） and 0. 185（ P = 0. 012）,respectively. There was a negative correlation between the plasma Lp-PLA2 level and the use of lipid-lowering drugs,while the correlation coefficient was 0. 153（ P =0. 038）. After a follow-up of 6 months,we found 10 new patients with cardiovascular and cerebrovascular diseases（ 6. 7%）. Eight of them were coronary heart diseases（ 5. 3%）. One of them was transient ischemic attack（ 0. 67%）. One of them was cerebral infarction（ 0. 67%）. A logistic regression model showed that abnormal LpPLA2 was the only important risk factor which influenced the incidence of cardiovascular and cerebrovascular diseases（ P = 0. 046）. Conclusion： The abnormal Lp-PLA2 is closely related with the incidence of cardiovascular and cerebrovascular diseases. It can help us screening people with high risk with Lp-PLA2 test in the elderly people health examination,and it has important significance for prevention and treatment in cardiovascular and cerebrovascular diseases.