脂蛋白相关磷脂酶A2在不同类型冠心病患者中的分布

Lipoprotein associated phospholipase A2 in different types of coronary heart disease

目的探讨脂蛋白相关磷脂酶A2在不同类型冠心病患者中的分布。方法 258例冠心病患者依据临床症状及冠脉造影结果将患者分为稳定性心绞痛(78例)、不稳定性心绞痛(122例)及急性心肌梗死(58例)三组,分析各组患者中脂蛋白相关磷脂酶A2(LP-PLA2)的分布差异。结果 (1)三组患者在年龄、他汀服用史、高血压史、糖尿病史、既往PCI史以及LDLC、apo-B、单支病变、双支及多支病变的分布上无统计学差异;三组患者的性别比例及吸烟比例有统计学差异,其中男性患者比例在急性心肌梗死组最高,三组的比例分别为51.3%,68.9,93.1%,P=0.001;吸烟比例在急性心肌梗死组最高,三组的比例为30.8%,31.3%,58.6%,P=0.025;(2)高密度脂蛋白(HDL-C,mmol·L^(-1))在稳定性心绞痛组数值分布最高,急性心肌梗死组最低,数值依次为(1.06±0.20),(0.95±0.21),(0.84±0.21),P<0.001;超敏C反应蛋白(Hs-CRP,mg·L^(-1))及Gensini积分在急性心肌梗死组最高,稳定性心绞痛组最低,Hs-CRP数值分别为(3.59±0.50),(6.68±1.44),(9.90±1.54),P<0.001),Gensini积分分别为(31.55±3.32),(41.75±1.47),(70.79±5.62),P=0.001;(3)Lp-PLA2(μg·L^(-1))在稳定性心绞痛组数值最低,在急性心肌梗死组数值最高,依次为(131.21±29.74),(250.77±50.32),(334.10±53.67),P<0.001。结论Lp-PLA2在不同类型冠心病分布中有差异,有望通过测定Lp-PLA2水平识别发生急性冠脉事件的高危人群,为冠心病药物治疗提供新的靶向处理。

Objective To investigate lipoprotein associated phospholipase A2（ Lp-PLA2） in different types of coronary heart disease.Methods 258 patients were divided into three groups： the first group（ stable angina pectoris,containing 78 patients）,the second group（ unstable angina pectoris,containing 122 patients）,and the third group（ acute myocardial infarction,containing 58 patients）.The differences of Lp-PLA2 in the three groups were detected and compared. Results（ 1） There was no statistical difference in terms of age,history of statins,hypertension,diabetes,PCI and LDL-C,apo-B,numbers of diseased coronary branches in three groups.The percentage of male patients（ 51. 3% vs 68. 9% vs 93. 1%,P = 0. 001）,and history of smoking（ 30. 8% vs 31. 3% vs 58. 6%,P= 0. 025） in the third group were significantly higher than the other two groups,（ 2） Hs-CRP（ mg·L^-1） and the score of Gensini were the highest in the third group. The values of Hs- CRP in each group are（ 3. 59 ± 0. 50）,（ 6. 68 ± 1. 44）,（ 9. 90 ± 1. 54）,P〈0. 001 and Gensini（ 31. 55 ± 3. 32）,（ 41. 75 ± 1. 47）,（ 70. 79 ± 5. 62）,P = 0. 001; but the level of HDL-C was the highest in the first group（ 1. 06 ± 0. 20）,（ 0. 95 ± 0. 21）,（ 0. 84 ± 0. 21）,P〈0. 001）;（ 2） There was significant difference in the three groups regarding LpPLA2（ μg·L^-1）（ 131. 21 ± 29. 74）,（ 250. 77 ± 50. 32）,（ 334. 10 ± 53. 67）,P〈0. 001. Lp-PLA2 was the highest in the third group,with statistical significance. Conclusions The level of plasma Lp-PLA2 may be a parameter to predict the risk of acute coronary heart disease,and Lp-PLA2 may provide a new target for the treatment of CHD.