冠状动脉慢血流病人血浆脂蛋白相关磷脂酶A2的变化及其临床价值

The changes and clinical value of plasma lipoprotein-associated phospholipase A2 in patients with coronary slow flow

目的探讨血浆脂蛋白相关磷脂酶A2(Lp-PLA2)水平与冠状动脉慢血流(CSF)的关系,以及老年与非老年CSF病人的临床特点。方法本研究共纳入65例经冠状动脉造影证实的CSF病人(CSF组)和60例冠状动脉血管及血流正常的病人(对照组),并分别根据年龄分为老年组和非老年组。采用校正的心肌梗死溶栓治疗血流记帧法计数(TFC)测定冠状动脉血流速度,测定并比较2组血生化指标和Lp-PLA2水平。结果老年CSF病人中,女性病人比例明显高于非老年组(P=0.006)。与相应对照组相比,老年CSF组和非老年CSF组病人Lp-PLA2水平明显升高(P<0.05),左前降支、左回旋支和右冠状动脉的心肌梗死溶栓治疗TFC和平均TFC均显著更高(P<0.001)。随着CSF涉及的冠状动脉数量的增加,Lp-PLA2的水平逐渐增加。Logistic回归分析显示,Lp-PLA2是老年CSF(OR=1.019,95%CI:1.002~1.037,P<0.05)和非老年CSF(OR=1.015,95%CI:1.000~1.030,P<0.05)共同的独立预测因素。结论CSF病人Lp-PLA2水平较高,是CSF的独立预测因素,且与CSF的严重程度相关。在老年病人中的研究结果与非老年病人一致,Lp-PLA2可能成为CSF的一种新的临床诊断生物标志物。

Objective To investigate the relationship between the plasma level of lipoprotein-associated phospholipase A2(Lp-PLA2)and coronary slow flow(CSF),and the clinical features of the elderly and non-elderly CSF patients.Methods A total of 65 CSF patients diagnosed by coronary arteriography(CSF group)and 60 patients with normal coronary arteries and normal coronary flow(control group)were enrolled,and they were further divided into elderly group and non-elderly group according to age respectively.Coronary flow velocity was detected by the correcting thrombolysis in myocardial infarction(TIMI)frame recording count(TFC).The levels of plasma biochemical index and Lp-PLA2 were measured and compared in all patients.Results The proportion of female patients in elderly CSF group was significantly higher than that in non-elderly CSF group(P=0.006).Compared to the corresponding control group,the levels of Lp-PLA2 were significantly increased(P<0.05),and the mean TFC of the left anterior descending artery,the left circumflex artery and the right coronary artery were all significantly increased in elderly CSF group and non-elderly CSF group(P<0.001).The level of Lp-PLA2 was increased with the increased number of involved coronary arteries in CSF.Logistic regression analysis showed that the level of Lp-PLA2 in the was independent predictors for CSF in the elderly patients(OR=1.019,95%CI:1.002-1.037,P<0.05)and in the non-elderly patients(OR=1.015,95%CI:1.000-1.030,P<0.05).Conclusions Plasma level of Lp-PLA2 is a higher in CSF patients and it is an independent predictor for CSF,which correlated with the extent and severity of CSF.Lp-PLA2 may become an alternative new clinical diagnostic biomarker for CSF.