脂蛋白相关磷脂酶A2与老年冠心病患者PCI术后心肌损伤的相关性研究

Correlation research between lipoprotein-associated phospholipase A2 and myocardial injury after PCI in elderly patients with coronary heart disease

目的探讨老年冠心病患者脂蛋白相关磷脂酶A2(Lp-PLA2)与经皮冠状动脉介入术(PCI)围术期心肌损伤(PMI)的关系及其预测价值。方法纳入2016年1月至2018年6月我院行PCI的老年冠心病患者100例,收集基线资料,检测PCI术前术后心肌肌钙蛋白T(cTnT)、高敏C反应蛋白(hs-CRP)、Lp-PLA2及其他生物化学指标。根据术后cTnT是否升高,将患者分为对照组(cTnT未升高)55例和观察组(cTnT升高)45例。比较2组的临床资料和PCI术中情况。Logistic回归分析PMI的危险因素。结果 2组高血压病史、糖尿病史、吸烟史、既往PCI史、他汀类药物服用史、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、肌酐、N端B型利钠肽原差异均无统计学意义(P>0.05),观察组载脂蛋白B水平高于对照组(P<0.05)。观察组Lp-PLA2及hs-CRP水平较对照组明显升高(P<0.05)。观察组Gensini积分、支架数量、支架释放压、手术用时明显大于对照组(P<0.05)。Logistic回归分析显示,Lp-PLA2(OR 4.55,95%CI 1.43~14.47)、Gensini积分(OR 1.08,95%CI 1.01~1.14)、支架数量(OR 5.35,95%CI 2.04~14.01)以及手术用时(OR 1.06,95%CI 1.00~1.12)为PMI相关危险因素。结论术前Lp-PLA2升高是老年冠心病患者PCI相关心肌损伤的危险因素,对PMI有预测价值。

Aim To investigate the relationship between lipoprotein-associated phospholipase A2 ( Lp-PLA2) and perioperative myocardial injury ( PMI) in elderly patients with coronary heart disease and its predictive value. Methods From January 2016 to June 2018, 100 elderly patients with coronary heart disease who underwent PCI in our hospital were included in the study. Baseline data of patients were collected, and cardiac troponin T ( cTnT), high-sensitivity C-reactive protein ( hs-CRP), Lp-PLA2 and other biochemical parameters were measured before and after PCI operation. According to whether cTnT was elevated or not after PCI operation, the patients were divided into control group (55 cases without elevation of cTnT) and observation group (45 cases with elevation of cTnT). Clinical data and intraoperative status of PCI were compared between the two groups. Logistic regression was used to analyze the risk factors of PMI. Results There were no significant differences in hypertension, diabetes, smoking, PCI, statins use, high density lipoprotein cholesterol, low density lipoprotein cholesterol, creatinine and N-terminal pro-B-type natriuretic peptide between the two groups (P>0. 05 ). The level of apolipoprotein B in observation group was higher than that in control group ( P<0. 05 ). The levels of Lp-PLA2 and hs-CRP in the observation group were significantly higher than those in the control group (P<0. 05). Gensini integral, stent number, stent release pressure and operation time in observation group were significantly higher than those in control group ( P<0. 05). Logistic regression analysis showed that Lp-PLA2 ( OR 4. 55 , 95% CI 1.43-14. 47), Gensini score (OR 1.08, 95% CI 1.01-1. 14), stent number ( OR 5. 35 , 95% CI 2. 04-14.01) and operation time ( OR 1. 06, 95% CI 1. 00-1. 12) were risk factors for PMI. Conclusion Preoperative elevation of Lp-PLA2 is a risk factor for PCI-related myocardial injury in elderly patients with coronary heart disease and has predictive value for PMI.