脂蛋白相关磷脂酶A2与冠脉斑块严重程度的关系及不同剂量瑞舒伐他汀对其浓度的影响

Relationship of Lp-PLA2 and Severity of Coronary Plaque and Effects of Rosuvastatin at Different Doses on the Concentration of Lp-PLA2

目的:分析脂蛋白相关磷脂酶A2(Lp-PLA2)与冠脉粥样硬化严重程度关系,评估不同剂量瑞舒伐他汀对血浆LpPLA2浓度的影响。方法:152例可疑冠心病患者根据冠脉造影检查结果分为冠心病组(n=117)与对照组(无冠心病,n=35)。采取Gensini积分量表,同时参照冠脉病变支数评估患者冠脉粥样硬化程度,并检测患者血浆Lp-PLA2水平,采用多元逻辑回归分析Lp-PLA2水平与冠脉斑块严重程度的相关性。将冠心病组患者再随机分为两组,分别给予常规剂量(10 mg·d^(-1))与负荷剂量(20 mg·d^(-1))瑞舒伐他汀,测定服药后2周、4周、8周及12周血浆Lp-PLA2浓度。结果:对照组血浆LpPLA水平为(22.22±1.75)μmol·ml^(-1),冠心病组为(29.03±3.99)μmol·ml^(-1),差异有统计学意义(P<0.05);冠心病不同Gensini积分组Lp-PLA2水平差异有统计学意义(P<0.05),分值越高,患者Lp-PLA2水平越高。多因素回归分析结果显示,冠脉粥样硬化程度与Lp-PLA2水平呈明显正相关(OR=1.613,P<0.05)。服药2,4,8,12周后,负荷剂量组Lp-PLA2水平均明显低于常规剂量组(P<0.05);冠脉狭窄程度评分明显低于常规剂量组(P<0.05)。常规剂量组心血管不良事件发生率(27.12%)明显高于负荷剂量组(6.90%)(P<0.05);两组药物不良反应发生率差异无统计学意义(11.86%vs 18.97%)(P>0.05)。结论:Lp-PLA2与冠脉斑块严重程度相关,采取大剂量瑞舒伐他汀方案可降低患者血浆Lp-PLA2浓度水平。

Objective： To analyze the relationship of lipoprotein associated phospholipase A2 （Lp-PLA2） and severity of coronary atherasclerosis, and evaluate the effects of rosuvastatin at different doses on the concentration of plasma Lp-PLA2. Methods： Totally 152 cases of patients with suspected coronary heart disease were treated with coronary angiography. According to the results of angiogra- phy, the patients were divided into the coronary heart disease group （n = 117 ） and the normal control group （without coronary heart disease, n = 35 ）. Gensini integral scale was performed and refening to the number of diseased coronary arteries, the degree of coronary atherosclerosis was evaluated. The concentration of serum Lp-PLA2 was detected and the relationship of Lp-PLA2 and the severity of coronary plaque was evaluated. Meanwhile, the patients with coronary heart disease were divided into 2 groups and orally treated with rosuvastatin respectively at the routine dose （ 10 mg·d-1 ） and the loading dose （20mg·d-1 ）. The changes of the plasma concentra- tion of Lp-PLA2 before the treatment, in the 2th, 4th ,8th and 12th week after the medication were measured and the effect of atorvastatin at different doses on the plasma concentration of Lp-PLA2 was summarized. Results： The plasma Lp-PLA level in the control group was （ 22.22 ± 1.75 ） μmol·ml-1, while that in the coronary heart disease group was （29.03 ± 3.99 ） μmol·ml-1 （ P 〈 0.05 ）. The differences in Lp-PLA2 levels between the groups with different Gensini scores of coronary heart disease were statistically significant （ P 〈 0.05 ）. The higher scores were, the higher Lp-PLA2 levels were. The results of multivariate analysis showed that the severity of cor- onary atherosclerosis was significant and positive correlated with Lp-PLA2 level （OR = 1. 613 ,P 〈0.05）. In the 2nd, 4th, 8th and 12th week after the medication, Lp-PLA2 levels in the loading dose group were significantly lower than those in the routine dose group （P 〈 0.05）. In the 2nd, 4th, 8th and 12th week after the medication, the degree scores of coronary artery stenosis in the loading dose group were reduced. The decreasing range was significantly greater than that in the routine dose group （ P 〈 0.05 ）. The incidence of adverse cardiovascular events in the routine dose group （27.12%） was significantly higher than that in the loading dose group （6.90%） （P 〈 0.05 ）. The incidence of adverse drug reactions in the routine dose group was 11.86%, while that in the loading dose group was 18.97% （P 〉 0.05）. Conclusion： Lp-PLA2 is correlated with the severity of coronary plaque. High dose of rosuvastatin can reduce plasma Lp-PLA2 concentration in the patients.