脂蛋白相关磷脂酶A2在急性冠脉综合征中的临床价值

Clinical value of lipoprotein-associated phospholipase A2 in acute coronary syndrome

目的:探讨脂蛋白相关磷脂酶A2(Lp-LA2)在急性冠脉综合征(ACS)中的临床价值。方法:收集2017-11—2018-04心内科128例冠心病患者为研究对象,根据临床分型将其分为急性心肌梗死组86例,不稳定性心绞痛组42例,并进一步将急性心肌梗死组细分为ST段抬高型心肌梗死组62例,非ST段抬高型心肌梗死组24例。此外,根据全球急性冠状动脉事件注册评分(GRACE)系统将所有入选的ACS患者危险分层,分为低危组46例,中危组28例,高危组54例,同步对所有入选患者进行血清Lp-LA2以及其他常规心肌损伤指标进行检测,并收集患者临床信息资料。结果:急性心肌梗死患者血清中Lp-LA2水平高于不稳定性心绞痛组,且ST段抬高型心肌梗死组患者血清中Lp-LA2水平高于非ST段抬高型心肌梗死组,差异有统计学意义(P<0.05);急性心肌梗死患者传统心肌损伤标志物如AST、CK-MB、Hs-TnI等水平也显著高于不稳定性心绞痛组,差异有统计学意义(P<0.05);根据GRACE评分,高危组中血清Lp-LA2水平显著高于中、低危组,差异有统计学意义(P<0.05);受试者工作特征曲线(ROC)分析结果显示Hs-TnI、BNP、LP-LA2、CK-MB、CK曲线下面积分别为0.947,0.889,0.826,0.805,0.795,其中以Hs-TnI最高,LP-LA2居中。结论:血清Lp-LA2可用于ACS危险分层评估,且联合Hs-TnI、BNP可对ACS进行诊断及预后评估。

Objective：To explore the clinical value of lipoprotein-associated phospholipase A2（Lp-LA2）in patients with acute coronary syndrome（ACS）.Method：128 patients with coronary heart disease in the Department of Cardiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were selected as subjects from November 2017 to April 2018.According to clinical classification,patients were divided into 86 cases of acute myocardial infarction group,42 cases of unstable angina pectoris.Acute myocardial infarction group was further subdivided into 62 cases of STEMI group and 24 cases of NSTEMI group.In addition,according to the GRACE system,all patients with acute coronary syndromes were stratified.They were divided into 46 cases of lowrisk group,28 cases of moderate-risk group,and 54 cases of high-risk group.All selected patients were detected the levels of serum Lp-LA2 and other routine myocardial injury markers and the clinical information of patients were collected.Result：The levels of serum Lp-LA2 in patients with acute myocardial infarction（AMI）were higher than those in unstable angina group,and the levels of serum Lp-LA2 in patients with STEMI were higher than those in NSTEMI subgroups.The difference was statistically significant（P〈0.05）.Traditional myocardial injury markers such as AST,CK-MB and Hs-TnI in patients with AMI were significantly higher than those in unstable angina（P〈0.05）.According to the GRACE score,the levels of serum Lp-LA2 were significantly higher in the high-risk group than in the middle-and low-risk group,with statistically significant differences（P〈0.05）.The receiver operating characteristic（ROC）analysis results showed that the areas under the curve of Hs-TnI,BNP,LP-LA2,CKMB,and CK were 0.947,0.889,0.826,0.805,and 0.795 respectively.Among them,Hs-TnI was the highest and Lp-LA2 was centered.Conclusion：Serum Lp-LA2 can be used for risk stratification assessment of ACS,and it can be combined with Hs-TnI,BNP to diagnose ACS.