Lp-PLA2、Lp(a)及Cys C对老年急性冠脉综合征病人风险评估的价值

Value of lipoprotein-associated phospholipase A2,lipoprotein( a),cystatin C in risk assessment of elderly patients with acute coronary syndrome

目的探讨老年急性冠脉综合征(ACS)病人血清脂蛋白相关磷脂酶A2(Lp-PLA2)、脂蛋白(a)[Lp(a)]、胱抑素C(Cys C)的表达水平及其在老年ACS病人风险评估中的价值。方法选择2016年5月至2018年5月在宜兴市人民医院心内科住院的120例老年ACS病人,并按照全球急性冠状动脉事件注册(GRACE)评分分为高危组(38例)、中危组(46例)和低危组(36例),选择同期的老年稳定型心绞痛病人50例作为对照组。收集所有病人的基线资料,检测心肌肌钙蛋白(cTNT)、高敏C反应蛋白(hs-CRP)、血脂、生化、Lp-PLA2、Cys C、Lp(a)水平。结果老年ACS病人血清Lp-PLA2、Cys C、Lp(a)水平显著高于老年稳定型心绞痛病人(P<0.05),并且高危组病人的Lp-PLA2、Cys C、Lp(a)水平显著高于中危组和低危组(P<0.05)。老年ACS病人Lp-PLA2、Cys C、Lp(a)水平与GRACE评分呈正相关(均P<0.05)。高危组的高血压、糖尿病比例以及肌酐水平均显著高于中危组和低危组(P<0.05);多元线性回归结果显示:Lp-PLA2、Cys C和Lp(a)是预后不佳的高危影响因素(P<0.05)。结论老年ACS病人血清Lp-PLA2、Lp(a)、Cys C表达水平升高,并且与危险分层及预后密切相关,Lp-PLA2、Lp(a)以及Cys C可作为评估老年ACS病人风险的预测指标。

Objective To investigate the expression levels of serum lipoprotein-associated phospholipase A2(Lp-PLA2),lipoprotein(a)[Lp(a)],cystatin C(Cys C)in the elderly patients with acute coronary syndrome(ACS)and to analyze the value in risk assessment.Methods A total of 120 elderly patients with ACS hospitalized in department of cardiology of Yixing People s Hospital from May 2016 to May 2018 were enrolled.All the patients were divided into high-risk group(38 cases),medium-risk group(46 cases)and low-risk group(36 cases)according to the Global Acute Coronary Event Registration(GRACE)score.Fifty elderly patients with stable angina pectoris in the same period were selected as the control group.The baseline data of all patients were collected and the levels of cardiac troponin T(cTNT),high sensitivity C reactive protein(hs-CRP),blood lipid,biochemistry parameters,Lp-PLA2,Cys C and Lp(a)were measured.Results Serum levels of Lp-PLA2,Cys C and LP(a)in the elderly patients with ACS were significantly higher than those in the elderly patients with stable angina pectoris(P<0.05),and the levels of LP-PLA2,Cys C and LP(a)in high-risk group were significantly higher than those in middle-risk group and low-risk group(P<0.05).There was a significant positive correlation between Lp-PLA2,Cys C,LP(a)and GRACE score in the elderly patients with ACS(P<0.05).The proportion of hypertension,diabetes mellitus and creatinine in high-risk group were significantly higher than those in middle-risk group and low-risk group(P<0.05).Multiple linear regression analysis showed that Lp-PLA2,Cys C and LP(a)were high risk factors for poor prognosis(P<0.05).Conclusions The expressions of Lp-PLA2,Lp(a)and Cys C in the elderly patients with ACS are elevated,which are closely related to risk stratification and prognosis.Lp-PLA2,Lp(a)and Cys C can be used as predictors to evaluate the risk of elderly patients with ACS.