脂蛋白相关磷脂酶A2在老年冠心病患者中的临床应用价值

Clinical Application of Serum Lipoprotein-associated Phospholipase A2 in the Elderly with Coronary Heart Disease

目的了解冠状动脉出现斑块的老年患者血清中脂蛋白相关磷脂酶A2(lipoprotein associated phospholipase A2,Lp-PLA2)的水平,探讨Lp-PLA2在冠心病诊断与危险分层中的诊断价值。方法将2013年10月—2017年6月期间就诊的60岁及以上老年患者356例根据冠状动脉CT血管造影分为斑块组和对照组,斑块组根据病变血管支数分为单支、双支和多支冠状动脉病变亚组。检测所有研究对象的空腹血糖(glucose,GLU)、三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)和Lp-PLA2的血清学水平。分析上述指标在斑块组与对照组中的差异及其与斑块形成的相关性;分析Lp-PLA2与受累冠脉支数的相关性;评判Lp-PLA2是否为冠状动脉斑块形成的危险因素。结果斑块组患者的TG、GLU和Lp-PLA2水平高于对照组,HDL-C水平低于对照组,差异均有统计学意义。在男女亚组中,斑块的出现均伴有Lp-PLA2升高(P<0.05)Lp-PLA2水平随斑块累及的病变冠状动脉支数增加而升高(P<0.05)。与年龄、血脂或血糖等冠心病传统危险因素相比,Lp-PLA2水平与TC和LDL-C呈正相关,与HDL-C呈负相关。Logistic回归结果显示年龄、GLU、HDL-C和Lp-PLA2浓度均可作为老年患者冠状动脉出现斑块的独立危险因素。结论 LpPLA2水平在冠状动脉出现斑块的老年患者中升高,与斑块涉及的病变动脉支数呈正相关,提示Lp-PLA2升高是冠状动脉出现斑块的独立危险因素,对冠心病的发生与进展均具有辅助诊断价值。

Objective To investigate the serum level of lipoprotein-associated phospholipase A2（Lp-PLA2） in the elderly with coronary artery plaques and to explore the value of Lp-PLA2 in the diagnosis and risk stratification of coronary heart disease. Methods 356 elder aged 60 from Oct., 2013 to June, 2017 were collected and divided into plaque group and control group according to the results of coronary artery CT angiography; the plaque group was subdivided into 3 coronary arterial lesion subgroups： single, double and multivariable branch group; the levels of glucose（GLU）, triglycerides（TG）, total cholesterol（TC）, high-density lipoprotein cholesterol（HDL-C）, low-density lipoprotein cholesterol（LDL-C） and Lp-PLA2 were measured and analysis was made to the differences in these indicators between the 2 groups, the correlation of these indicators to the plague formation,the correlation between the level of Lp-PLA2 and the number of lesion coronary artery vessels, and an assessment was made to determine if Lp-PLA2 as a risk factor for coronary artery plaque formation. Results The levels of TG, GLU and Lp-PLA2 of the elder plaque group were higher than those in control group while the HDL-C level was lower than that in control group, the differences were statistically significant; the appearance of plaques was accompanied by an increase of the level of Lp-PLA2 and the level of Lp-PLA2 increased with the number increase of coronary artery lesions involved by plaques; Compared with age, blood lipid, blood glucose and other traditional risk factors of coronary heart disease, the level of Lp-PLA2 was positively correlated with the level of TC and LDL-C and negatively correlated with the level of HDL-C; logistic regression analysis indicated that age, glucose, HDL-C and Lp-PLA2 concentrations were the independent risk factors for coronary artery plaque in the elderly. Conclusions The increasing level of Lp-PLA2 is an independent risk factor for plaques in the coronary arteries;the level of Lp-PLA2 is of diagnostic value for the occurrence and progression of coronary heart disease.