血浆脂蛋白相关磷脂酶A2与冠状动脉病变程度及冠状动脉斑块形态的相关分析

Correlation analysis of plasma lipoprotein-associated phospholipase A2 with coronary lesion and coronary plaque morphology

目的探讨临床中血浆脂蛋白相关磷脂酶A2(Lp-PLA2)与冠状动脉病变程度及冠状动脉斑块形态的相关性。方法入选研究对象266例,其中急性冠状动脉综合征(ACS)患者140例,分为心绞痛组78例、急性心肌梗死组62例;对照组126例为同期行冠状动脉造影术示冠状动脉狭窄<50%的患者。根据造影结果对冠状动脉狭窄程度进行Gensini评分,并对冠状动脉病变形态进行分型。所有对象均检测Lp-PLA2及超敏C反应蛋白(hs-CRP)。结果心绞痛组、急性心肌梗死组的Lp-PLA2水平分别为(257.41±89.06)μg/L、(332.02±61.62)μg/L,均高于对照组(225.15±71.26)μg/L,差异有统计学意义(P<0.05),急性心肌梗死组Lp-PLA2水平高于心绞痛组,差异有统计学意义(P<0.01);Ⅱ、Ⅲ型病变患者平均血清hs-CRP、LP-PLA2水平显著高于Ⅰ型病变者(12.55±16.34)mg/L、(18.20±35.16)mg/L,(326.46±56.32)μg/L、(307.05±84.51)μg/L vs(4.49±9.40)mg/L,(256.96±97.73)μg/L(P<0.01),但Ⅱ型病变与Ⅲ型病变患者血清hs-CRP、LP-PLA2水平之间差异无统计学意义。经双变量相关性分析,血浆Lp-PLA2水平与hs-CRP、Gensini积分水平均呈正相关(r=0.277,P<0.01;r=0.174,P<0.01)。结论Lp-PLA2可反应冠心病的炎症活动情况及斑块的不稳定性,与冠状动脉病变的严重程度成正相关。

Objective To investigate the clinical plasma lipoprotein-associated phospholipase A2（Lp-PLA2）and extent of coronary artery disease and coronary plaque morphology correlation.Methods 266 subjects included 140 patients with acute coronary syndrome（ACS）,in which 78 patients with angina pectoris and 62 with acute myocardial infarction.In control group,126 cases for the same period underwent coronary angiography which showed coronary artery stenosis〈50%.Coronary artery stenosis was characterized by Gensini scores,coronary lesions morphology was classified into different types.Lp-PLA2 and high-sensitivity C-reactive protein（hs-CRP）were measured in all patients.Results Lp-PLA2 level in angina pectoris and acute myocardial infarction group was higher than that in control group（257.41±89.06）μg/L,（332.02±61.62）μg/L vs（225.15±71.26）μg/L（P〈0.05）,Lp-PLA2 concentration was higher in acute myocardial infarction group than that in angina group（P〈0.01）.Serum hs-CRP and LP-PLA2 level in typeⅡ,Ⅲ group were significantly higher than those in typeⅠ group（12.55±16.34）mg/L,（18.20±35.16）mg/L,（326.46±56.32）μg/L,（307.05±84.51）μg/L vs（4.49±9.40）mg/L,（256.96±97.73）μg/L（P 〈0.001）,but serum hs-CRP,LP-PLA2 level between type Ⅱ group and Ⅲ lesions group meant no statistical difference.By bivariate correlation analysis,plasma level of Lp-PLA2 was positive correlated with hs-CRP and Gensini scores（r=0.277,P 〈0.001;r=0.174,P〈0.01）.Conclusion Lp-PLA2 may react inflammation and plaque instability of coronary heart disease,and it was positive correlated with the severity of coronary artery disease.