脂蛋白相关磷脂酶A2与老年冠心病病人药物洗脱支架植入术后再狭窄的相关性

Relationship between serum lipoprotein-associated phospholipase A2 and intra-stent restenosis after drug-eluting stent implantation in elderly patients with coronary heart disease

目的探讨血清脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)水平与老年冠心病病人经皮冠状动脉介入治疗(pecutaneous coronary intervention,PCI)术后药物洗脱支架(drug-eluting stent,DES)内再狭窄(ISR)的相关性。方法选取102例经冠状动脉造影(coronary angiography,CAG)证实冠状动脉严重狭窄并行PCI术植入DES的老年冠心病病人,术后1年复查CAG显示支架段再次出现≥50%狭窄的病人11例为支架内再狭窄组(ISR组),CAG显示支架段内狭窄程度<50%或支架段内无狭窄的病人91例为非支架内再狭窄组(NISR组),比较2组病人的血脂及Lp-PLA2、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)等炎症指标水平。结果 ISR组病人血清炎症指标Lp-PLA2为(333.09±91.07)ng/ml,明显高于NISR组的(228.52±113.34)ng/ml(P<0.05),但hs-CRP水平差异无统计学意义(P>0.05),总胆固醇和低密度脂蛋白胆固醇水平在2组中差异亦无统计学意义(P>0.05);Logistic回归分析显示Lp-PLA2水平是ISR的独立危险因素。结论 LpPLA2可能是评估老年冠心病病人PCI术后ISR发生风险的独立预测因素之一。

Objective To investigate the relationship of serum lipoprotein-associated phospholipase A2（ Lp-PLA2） with intra-stent restenosis（ ISR） after drug-eluting stents（ DES）implantation in elderly patients with coronary heart disease. Methods Totally one hundred and two elderly patients with severe coronary artery stenosis confirmed by coronary angiography（ CAG） and treated with DES implantation were enrolled. All participants were followed up for at least 1 year and divided into ISR group which was defined as ≥ 50% restenosis of reference vessel diameter at stent segment and nonintra-stent restenosis（ NISR） group which was defined as 〈50% restenosis of reference vessel diameter or no restenosis at stent segment according to the consequence of CAG. The levels of lipid and inflammatory factors such as Lp-PLA2,hypersensitive C-reactive protein（ hs-CRP） were detected and compared between two groups. Results The serum level of Lp-PLA2 was significantly higher in ISR group compared with NISR group（ 333. 09±91. 07 ng/ml vs. 228. 52±113. 34 ng/ml,P〉0. 05）. But the level of hs-CRP was not significantly different between two groups（ P 0. 05）. No difference was found in the levels of total cholesterol and low density lipoprotein-cholesterol between two groups（ P0. 05）. Logistic regression analysis showed serum level of Lp-PLA2 was an independent predictor of ISR.Conclusions Serum level of Lp-PLA2 may be one of independent predictors in elderly patients with coronary heart disease who are at increased risk for restenosis after drug-eluting stent placement.