血清脂蛋白相关磷脂酶A2与不稳定心绞痛患者主要危险因素的相关性

Correlation between lipoprotein-associated phospholipase A2 and main risk factors in unstable angina pectoris patients

目的探讨血清脂蛋白相关磷脂酶A2（Lp-PLA2）与不稳定心绞痛患者主要危险因素的相关性。方法选择本院心脏内科2015-03~2015-06不稳定心绞痛住院就诊的52例患者为研究组,同期58例因胸痛行冠状动脉造影术（CAG）冠状动脉狭窄〈30%且排除冠心病的患者为对照组。不稳定心绞痛患者入院后24 h内采用TIMI评分进行危险分层以及Gensini积分,并检测血压,心率,肝、肾功能,血脂,凝血功能,心肌酶,N端脑利钠肽前体（NT-proBNP）,高敏性C反应蛋白等指标。ELISIA法测定血清Lp-PLA2水平,并评价Lp-PLA2与不稳定心绞痛主要危险因素的相关性。结果不稳定心绞痛组脂蛋白（a）、低密度脂蛋白、肌钙蛋白I、肌酸激酶、NT-proBNP、纤维蛋白降解产物（FDP）、hs-CRP和Lp-PLA2水平明显高于对照组（P〈0.05或P〈0.01）,Apo-A1则明显降低（P〈0.05）;TIMI评分高危组和中危组Lp-PLA2水平与Gensini积分高于低危组（P〈0.01）;不稳定心绞痛组血清Lp-PLA2水平与TIMI评分、Gensini积分、LDL、脂蛋白a、APTT以及D-二聚体呈现明显的正相关（P〈0.05）;Lp-PLA2水平与TIMI评分、Gensini积分、LDL和脂蛋白a呈线性回归。结论 Lp-PLA2水平是不稳定心绞痛高危人群危险程度和冠脉病变严重程度的有力预测因素,并且Lp-PLA2水平的升高也直接反映了LDL和脂蛋白（a）与动脉粥样硬化不稳定斑块发展的相关性。

Objective To investigate the correlation between lipoprotein-associated phosphotipase A2 （Lp-PLA2） and main risk factors of unstable angina pectoris（UA）. Methods Totally 52 patients with UA in Department of Cardiovascular Medicine from March 2015 to June 2015 were chosen as study group, and 58 chest pain patients with coronary stenosis 〈 30% detected by coronary angiography and non-coronary heart disease were chosen as control group. All UA patients were subjected to risk assessment and stratification with TIMI risk score and Gensini score within 24 h after admission, and blood pressure, heart rate, liver and renal function, blood lipids, coagulation function including prothrombin time （PT）, activated partial thromboplastin time （APTI＇）, fibrin degradation product （FDP）, fibrinogen and D-dimer, myocardial enzymes, NT-proBNP, and high sensitivity C reactive protein （hs-CRP） were determined. Lp-PLA2 was measured by enzyme-linked immunosorbent assay and its relationship with risk factors of UA was analyzed. Results The levels of Lp-PLA2, lipoprotein （a） ,low density lipoprotein, troponin I, creatine kinase, NT-proBNP, FDP and hs-CRP were significantly higher in UA group than in control group（ P 〈 0.05 or P 〈 0.01 ）, but Apo-A1 level was lower（ P 〈 0.05 ）. Lp-PLA2 level and Gensini score were significantly elevated in high and middle risk groups compared with low risk group（P 〈 0.01 ）. Lp-PLA2 level was positively correlated with TIMI risk score, Gensini score, LDL, lipoprotein （a）, APTT and D-dimer（ P 〈 0.05 ）. There was a linear regression between Lp-PLA2 level and TIMI risk score,Gensini score, LDL and lipoprotein（a）. Conclusion The level of Lp-PLA2 is a potent predictive factor as hazardous level and the severity of coronary lesion in UA patients. The higher level of Lp-PLA2 also direedy suggests the relation of LDL and lipoprotein（a） with unstable atherosclerotic plaque.