脂蛋白相关性磷脂酶A2对急性ST段抬高型心肌梗死的临床价值

Clinical value of serum lipoprotein associated phospholipase A2 in patients with acute ST-elevation myocardial infarction

目的探讨不同脂蛋白相关性磷脂酶A2(Lp-PLA2)水平对急性ST段抬高型心肌梗死患者的临床意义。方法回顾性分析2016年3月至2017年3月该院心血管内科收治的242例急性ST段抬高型心肌梗死患者的临床资料,根据Lp-PLA2水平分为Lp-PLA2增高组(164例)和Lp-PLA2正常组(78例),比较2组患者的基本资料、超声心动图及随访6个月过程中主要心血管不良事件(MACE)的发生情况等,根据冠脉造影结果分析Lp-PLA2水平与冠状动脉病变程度的关系。结果 Lp-PLA2与总胆固醇、低密度脂蛋白胆固醇呈正相关(r=0.501,P=0.023;r=0.653,P=0.017),Lp-PLA2水平与高密度脂蛋白胆固醇呈负相关(r=-0.436,P=0.028)。血Lp-PLA2水平随着冠脉病变支数的增加也相应增加,差异有统计学意义(P<0.05)。超声心动图检查发现Lp-PLA2正常组左心室舒张末内径及舒张功能下降的比例明显小于Lp-PLA2增高组,而左室射血分数明显高于Lp-PLA2增高组,差异均有统计学意义(P<0.05)。在6个月随访过程中,Lp-PLA2增高组MACE发生率均高于Lp-PLA2正常组,其中顽固性心绞痛、心力衰竭及猝死发生率比较,差异有统计学意义(P<0.05)。结论在急性ST段抬高型心肌梗死中,Lp-PLA2水平与冠状动脉病变严重程度相关,是心功能下降及不良预后的一个重要预测因子。

Objective To assess the clinical value of serum lipoprotein associated phospholipase A2（Lp-PLA2） levels in patients with acute ST-elevation myocardial infarction （STEMI）. Methods A total of 242 consecutive patients with STEMI were enrolled from March 2016 to March 2017 for retrospective study.The basic information,echocardiographic data and major adverse cardiovascular events （MACE） that followed up for six months in patients with hyper-Lp-PLA2 （ n =164） were compared with those in patients without hyper-Lp-PLA2 （ n =78）.The relationship between the level of serum Lp-PLA2 and the degree of diseased coronary artery was analyzed. Results Serum Lp-PLA2 correlated positively with total cholesterol,low density lipoprotein cholesterol （ r =0.501, P =0.023; r =0.653, P =0.017）,whereas correlated negatively with high density lipoprotein cholesterol （ r =-0.436, P =0.028）.And a significant association between serum Lp-PLA2 and one or more diseased vessels was observed （ P 〈0.05）.Left ventricular end-diastolic diameter and the rate of diastolic dysfunction were found to be more in hyper-Lp-PLA2 patients than those in the non-hyper-Lp-PLA2 patients （ P 〈 0.05）.Higher incidence in left systolic dysfunction was discovered in hyper-Lp-PLA2 patients （ P 〈 0.05 ）.Also,hyper-Lp-PLA2 patients had more follow-up MACE. Conclusion Serum Lp-PLA2 level correlated positively with the severity of coronary artery disease,hyper-Lp-PLA2 patients after STEMI tended to have higher incidence in left systolic dysfunction and diastolic dysfunction,and Lp-PLA2 is an important predictor for the risk of cardiovascular events.