青年不稳定型心绞痛患者冠脉病变与血浆脂蛋白相关磷脂酶A2的关系

Relationship between coronary arteriosclerosis of young patients with unstable angina and lipoprotein-associated phospholipase A2

目的探讨青年不稳定型心绞痛患者冠脉病变特点及与血清脂蛋白相关磷脂酶A2（Lp—PLA2）水平的关系。方法选择32例青年不稳定型心绞痛（UA）患者为研究组，30例稳定型心绞痛（SA）患者为对照组。使用血管内超声测定两组病变冠脉的血管外弹力膜面积（EEM）、管腔横截面积（LA）、斑块面积（PA）、斑块负荷（PB）、薄帽纤维粥样斑块（TCFA）、斑块偏心指数（E1）、重构指数（RI）等指标，并利用虚拟组织成像技术对斑块成分进行比较分析；同时使用酶联免疫吸附法（ELISA）检测两组患者血浆Lp—PLA2水平。结果UA组和SA组患者冠脉病变的LA、PA、PB相比较，均未见统计学差异（P〉0．05），但是UA组EEM、EI、RI较SA组显著升高，差异有统计学意义（P〈0．05）；UA组TCFA比例较SA组显著升高，差异有统计学意义（P〈0．01）；UA组斑块中脂质、坏死组织所占比例较SA组增高，而SA组斑块中纤维组织比例增高，差异有统计学意义（P〈0．01）；UA组血清Lp—PLA2水平较SA组显著增高（P〈0．01）。结论血浆Lp—PLA2水平可能反映青年UA患者冠脉病变斑块的稳定程度。

Objective To discuss the relationship between lipoprotein-assoeiated phospholipase A2 （Lp- PLA2） and coronary arteriosclerosis of young patients with unstable angina （UA）. Methods 62 patients with coro- nary artery disease were divided into UA group（n=32） and stable angina （SA）group（n=30）. The studied virtual histology intravascular ultrasound （VH-IVUS） parameters includeding the area of external elastic membrane（EEM ） of vascellum, lumens area （LA）, plaque area （PA）, plaque burden （PB）, thin cap fibroathroma （TCFA）, eccen- tricity index （EI） and remodeling index （RI） were measured by VH-IVUS in two groups. Geometric and composi- tional data were also obtained using intravascular ultrasound virtual histology software. The serum level of Lp-PLA2 was measured by ELISA. Results There were no significant differences in arterial plaques for LA, PA, PB be- tween UA and SA patients（P〉0.05）. The EEM, EI and RI in the patients of the UA group increased more signifi- cantly than that of the SA group （P〈0.05）. Compared to SA group, UA group had higher TCFA （P〈0.01）. The components of plaques were different between UA and SA patients. Compared to patients with SA, arterial plaques were associated with more lipidic and less fibrous components in UA patients （P〈0.O1）. The serum level of Lp- PLA2 in the patients of the UA group increased more significantly than the SA group （P〈O.01）. Conclusion The plasma level of Lp-PLA2 may reflect the stable degree of coronary arterial plaques in young patients with UA.