不同血压昼夜节律冠心病患者血浆同型半胱氨酸、血清脂蛋白相关磷脂酶A2水平变化及其与冠状动脉狭窄程度的关系研究

Changes of Plasma Hcy Level,Serum LP-PLA2 Level in Coronary Heart Disease Patients with Different Circadian Rhythm of Blood Pressure and Their Relations with Severity of Coronary Stenosis

背景血浆同型半胱氨酸(Hcy)、血清脂蛋白相关磷脂酶A2(LP-PLA2)水平是冠心病的危险因素,但血浆Hcy、血清LP-PLA2水平与冠心病患者血压昼夜节律及冠状动脉狭窄程度的关系等尚不明确。目的分析不同血压昼夜节律冠心病患者血浆Hcy、血清LP-PLA2水平变化,并探讨其与冠状动脉狭窄程度的关系。方法选取2016年4月—2018年8月粤北人民医院心内科收治的冠心病患者252例,按照血压昼夜节律分为A组58例(杓形血压)、B组130例(非杓形血压)、C组64例(反杓形血压)。比较3组患者一般资料〔包括性别、年龄、体质指数(BMI)〕、实验室检查指标{包括糖化血红蛋白(HbA1c)、超敏C反应蛋白(hs-CRP)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)、脂蛋白(a)〔Lp(a)〕、血浆Hcy水平、血清Lp-PLA2水平}、Gensini积分;血浆Hcy、血清Lp-PLA2水平与冠心病患者血压昼夜节律的相关性分析采用Spearman秩相关分析、多元线性回归分析,血浆Hcy、血清Lp-PLA2水平及血压昼夜节律与冠心病患者Gensini积分的相关性分析采用Pearson相关分析、多元线性回归分析。结果 (1)3组患者性别、年龄、BMI、HbA1c、hs-CRP、TC、TG、HDL-C、LDL-C、ApoA、ApoB、Lp(a)、血浆Hcy水平、Gensini积分比较,差异无统计学意义(P>0.05);C组患者血清LP-PLA2水平高于A、B组(P<0.05)。(2)血浆Hcy水平、血压昼夜节律未进入多元线性回归模型。相关性分析结果显示,血清LP-PLA2水平与冠心病患者血压昼夜节律(rs=0.26)、Gensini积分(r=0.03)呈正相关(P<0.05);多元线性回归分析结果显示,血清LP-PLA2水平与冠心病患者血压昼夜节律(β=0.001)、Gensini积分(β=0.001)呈正相关(P<0.05)。结论伴有反杓形血压的冠心病患者血清LP-PLA2水平高于伴有非杓形、杓形血压的冠心病患者,血清LP-PLA2水平与冠心病患者血压昼夜节律及冠状动脉狭窄程度呈正相关;血浆Hcy水平与冠心病患者血压昼夜节律、冠状动脉狭窄程度无直线相关关系,而血压昼夜节律与冠心病患者冠状动脉狭窄程度也无直线相关关系。

Background Plasma Hcy level and serum LP-PLA2 level are risk factors of coronary heart disease, but relations of plasma Hcy level and serum LP-PLA2 level with circadian rhythm of blood pressure and severity of coronary stenosis are not clear in patients with coronary heart disease. Objective To analyze the changes of plasma Hcy level,serum LP-PLA2 level in coronary heart disease patients with different circadian rhythm of blood pressure and their relations with severity of coronary stenosis. Methods From April 2016 to August 2018,252 patients with coronary heart disease were selected in the Department of Cardiology,the People's Hospital of North Guangdong,and they were divided into A group(with dipper type blood pressure,n=58),B group(with non-dipper blood pressure,n=130)and C group(with anti-arytenoid blood pressure,n=64)according to the circadian rhythm of blood pressure. General information(including gender,age and BMI),laboratory examination results〔including HbA1c,hs-CRP,TC,TG,HDL-C,LDL-C,ApoA,ApoB,Lp(a), plasma Hcy level and serum Lp-PLA2 level〕and Gensini score were compared in the three groups;Spearman rank correlation analysis and multivariate linear-regression analysis were used to analyze the correlations of plasma Hcy level and serum Lp-PLA2 level with circadian rhythm of blood pressure in patients with coronary heart disease,meanwhile Pearson correlation analysis and multivariate linear-regression analysis were used to analyze the relations of plasma Hcy level,serum Lp-PLA2 level,circadian rhythm of blood pressure with severity of coronary stenosis in patients with coronary heart disease. Results (1)No statistically significant difference of gender,age,BMI,HbA1c,hs-CRP,TC,TG,HDL-C,LDL-C,ApoA,ApoB,Lp(a), plasma Hcy level or Gensini score was found in the three groups(P>0.05),while serum LP-PLA2 in C group was statistically significantly higher than that in A group and B group,respectively(P<0.05).(2)Plasma Hcy level and circadian rhythm of blood pressure are not coincident with the condition of multivariate linear-regression analysis. Correlation analysis results showed that,serum LP-PLA2 level was positively correlated with circadian rhythm of blood pressure(rs=0.26)and Gensini score(r=0.03) in patients with coronary heart disease,respectively(P<0.05);multivariate linear-regression analysis results showed that, serum LP-PLA2 level were positively correlated with circadian rhythm of blood pressure(β= 0.001)and Gensini score(β= 0.001) in patients with coronary heart disease,respectively(P<0.05). Conclusion Serum LP-PLA2 level significantly increases in coronary heart disease patients with anti-arytenoid blood pressure compared with that in coronary heart disease patients with dipper or non-dipper blood pressure,and serum LP-PLA2 level are positively correlated with circadian rhythm of blood pressure and severity of coronary stenosis in patients with coronary heart disease;plasma Hcy level is not linearly correlated with circadian rhythm of blood pressure or severity of coronary stenosis in patients with coronary heart disease,moreover circadian rhythm of blood pressure is not linearly correlated with severity of coronary stenosis,too.