血浆脂蛋白相关磷脂酶A2对急性心肌梗死患者住院预后的影响

Impact of 1ipoprotein-associated phospholipase A2 on adverse cardiovascular events in hospitalized patients with acute myocardial infarction

目的:探讨血浆脂蛋白相关磷脂酶A2(Lp-PLA2)对急性心肌梗死(AMI)患者在住院期间发生不良心血管事件的影响。方法:收集明确诊断为AMI的住院患者167例,依据ST段抬高与否分为ST段抬高型心肌梗死STEMI组(86例)及非ST段抬高型心肌梗死NSTEMI组(81例);同时收集非急性心肌梗死80例作为对照组,记录在院期间的主要不良心血管事件(包括心源性死亡、再发心肌梗死、心力衰竭、恶性心律失常、反复缺血性心绞痛发作等)。比较3组患者血浆Lp-PLA2水平并分析血浆Lp-PLA2水平与患者在住院期间发生不良心血管事件的相关性。结果:(1)AMI患者Lp-PLA2水平高于对照组,且在STEMI组升高最明显,组间比较差异有统计学意义,P<0.05;(2)心血管事件发生率随着Lp-PLA2水平的升高而呈明显上升趋势,P<0.05;(3)AMI患者中不良事件发生组Lp-PLA2水平显著高于无不良事件发生组的患者[(288.732±124.873)ng/m L对(231.537±92.059)ng/m L],P<0.05。(4)经Logistic回归分析发现Lp-PLA2水平是影响AMI患者院内心血管事件发生率的一个独立危险因素,P<0.05。结论:Lp-PLA2对AMI患者院内不良心血管事件的发生有一定的预测价值,检测血浆Lp-PLA2水平可优化AMI患者院内风险评估。

Objective： To determine the prognostic utility of lipoprotein-associated phospholipase A2（Lp-PLA2） for in-hospital major adverse cardiovascular events（MACE）in patients with acute myocardial infarction（AMI）. Methods： A total of 167 patients referred for AMI participated, including 86 patients who were diagnosed as ST-segment elevation AMI（STEMI） and 81 patients without ST-elevation（non-STEMI））,while 80 patients without AMI were selected as the control group. The following in-hospital MACE were recorded： death,remyocardial infarction, angina pectoris after MI, acute heart failure, and life threatening arrhythmias. The Lp-PLA2 levels among each group were compared, and the correlation between in-hospital MACE and Lp-PLA2 levels was explored. Results：（1）The plasma concentration of Lp-PLA2 was higher in patients with AMI than those of the control group, and the STEMI group was the highest, P〈0.05;（2）The occurrence rate of in-hospital MACE was elevated significantly with the increased level of Lp-PLA2, P〈0.05;（3） Levels of Lp-PLA2 were significantly higher in patients suffered from an event than those event-free subjects [（288.732±124.873）ng/ m L vs（231.537±92.059）ng/m L],P〈0.05;（4）Lp-PLA2 was found tObe an independent risk factor in AMI patients for the in-hospital MACE in the regression analysis. Conclusion：Lp-PLA2 is positively correlated with the in-hospital adverse cardiovascular events in patients with AMI, and it＇s an important biomarker in the risk stratification for in-hospital AMI patients.