急性冠状动脉综合征患者血清血栓调节蛋白和脂蛋白相关磷脂酶A2水平变化及临床意义

Change and relationship of serum thrombomodulin and lipoprotein-associated phospholipase A2 in patients with acute coronary syndrome

目的:检测急性冠状动脉综合征(ACS)患者血清血栓调节蛋白(TM)及脂蛋白相关磷脂酶A2(Lp-PLA2)水平变化及临床意义。方法:入选冠心病患者120例,分为ACS组69例和稳定性心绞痛(SAP)组51例。再将120例冠心病患者按病变血管支数分为单支病变组(45例)、双支病变组(38例)和3支病变组(37例)。采用Gensini评分系统评定冠状动脉血管病变狭窄程度,按Gensini积分分为轻度病变组(<26分)36例、中度病变组(26~54分)48例和重度病变组(>54分)36例。另选同期有胸痛症状CTA正常的患者20例为对照组。用酶联免疫吸附试验(ELISA)法分别检测血清TM、Lp-PLA2水平。结果:与对照组比较,SAP组、ACS组血清TM、Lp-PLA2水平均明显升高;与SAP组比较,ACS组血清TM、Lp-PLA2均明显升高。单支病变组、双支病变组及3支病变组血清TM、Lp-PLA2均差异无统计学意义。重度病变组血清TM水平明显高于中度病变组和轻度病变组(均P<0.05)。轻度病变组、中度病变组和重度病变组血清Lp-PLA2均差异无统计学意义(P>0.05)。ACS组患者血清TM和Lp-PLA2间呈正相关,而SAP组和对照组间无相关。结论:ACS患者血清TM和Lp-PLA2均升高,说明炎性反应及内皮功能损伤参与了ACS的发病过程,并且两者可能有协同作用。

Objective:Aim To investigate the change and relationship of serum thrombomodulin(TM)and lipoprotein-associated phospholipase A2(Lp-PLA2)in patients with ACS and its clinical significance.in Patients with Acute Coronary Syndrome.Methods:One hundred and twenty patients with coronary heart disease(CHD)were categorized into 2 groups:69 with ACS and 51 with stable angina pectoris(SAP);20 patients with chest pain and normal angiography served as a control group.The 120 patients with CHD were categorized into single vessel disease group,double vessels disease group and three vessels disease group based on the number of coronary artery stenosis.The severity of coronary artery stenosis was quantified based on coronary angiography using Gensini score.They were further divided into mild CHD group with its Gensini score<26(n=36),moderate CHD group with its Gensini score being 26-54(n=48)and severe CHD group with its Gensini score>54(n=36).Serum levels of TM and Lp-PLA2 of different groups were determined by enzyme-linked immunosorbent assay(ELISA).Correlation between TM and Gensini score were analyzed.Results:The serum TM and Lp-PLA2 levels were significantly higher in the ACS group and SAP than those in control group.The serum TM and Lp-PLA2 levels were significantly higher in the ACS group than SAP.The serum TM and Lp-PLA2 levels were no-significant difference among control group,single vessel disease group,double vessels disease group and three vessels disease group(P>0.05 for each comparison).The serum TM levels were significantly higher in the severe CHD group with its Gensini score>54 than those in moderate CHD group with its Gensini score being 26-54 and mild CHD group with its Gensini score<26.The serum Lp-PLA2 levels were no-significant difference among control group,mild CHD group with its Gensini score<26,moderate CHD group with its Gensini score being 26-54 and severe CHD group with its Gensini score>54(P>0.05 for each comparison).And there were a postive correlation between TM and Lp-PLA2 values and in the patients with ACS.But there were not a correlation between TM and Lp-PLA2 in SAP group and control group.Conclusions:The levels of TM and Lp-PLA2 will be increase in the patients with ACS.There are a relationship between ACS and inflammation,blood vessel endothelial dysfunction and they can promote and influence each other.