急性心肌梗死患者血清脂蛋白相关磷脂酶A2的表达及其与冠状动脉病变程度和预后的相关性

Expression of lipoprotein-associated phospholipase A2 and its correlation with the severity of coronary lesions and clinical prognosis in patients with acute myocardial infarction

目的:研究急性心肌梗死(AMI)患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)的表达及其与冠状动脉(冠脉)病变程度及预后的关系。方法:选取2017-06-2018-10于西安交通大学第一附属医院心内科就诊的740例AMI患者为研究对象,依据患者检测的Lp-PLA2水平的中位数180 pg/ml为切点,分为Lp-PLA2升高组(316例)和Lp-PLA2正常组(424例)。采用ELISA法测定血浆Lp-PLA2浓度,采用Gensini评分评估冠脉病变程度。比较2组患者资料,分析Lp-PLA2水平与临床指标的相关性。随访12个月,比较2组心血管不良事件的发生率。结果:Lp-PLA2升高组白细胞计数(WBC)、中性粒细胞百分比(NEUT)、心肌肌钙蛋白T(cTnT)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、D-二聚体、高敏C反应蛋白(hs-CRP)、冠脉病变支数、Gensini积分、多支病变等指标水平均高于Lp-PLA2正常组,组间比较差异有统计学意义(均P<0.05)。Spearman相关分析显示,Lp-PLA2水平与Gensini积分、hs-CRP、LDL-C和D-二聚体呈正相关性(r=0.187、0.196、0.323、0.075,均P<0.05)。进一步多因素分析显示,TC(OR:0.442,95%CI:0.256~0.694,P<0.05)、LDL-C(OR:5.656,95%CI:2.944~10.868,P<0.05)、hs-CRP(OR:1.127,95%CI:1.082~1.174,P<0.05)、D-二聚体(OR:1.310,95%CI:1.075~1.596,P<0.05)是Lp-PLA2表达的相关因素。Lp-PLA2升高组12个月心血管不良事件发生率为18.35%(62/316),高于Lp-PLA2正常组的12.50%(59/424),差异具有统计学意义(P<0.05)。结论:AMI患者Lp-PLA2水平与LDL-C、hs-CRP及D-二聚体相关,与冠脉病变程度及预后有密切的相关性。

Objective:To investigate the expression of plasma lipoprotein-associated phospholipase A2(Lp-PLA2)and its correlation with the severity of coronary lesions and clinical prognosis in patients with acute myocardial infarction(AMI).Method:A total of 740 AMI patients were enrolled and divided into a high expression group(n=316)and a normal expression group(n=424)according to the median expression level of plasma Lp-PLA2(180 pg/ml).The plasma Lp-PLA2 concentration was measured by the ELISA test,and the degree of coroany artery disease was calculated by the Gensini score.Clinical data were collected and compared;the relationship between Lp-PLA2 and clinic indexes was analyzed.All patients were followed up for 12 months to compare the incidence of cardiovascular adverse events between the two groups.Result:The levels of WBC,NEUT,cTnT,TC,LDL-C,D-dimer,hs-CRP,number of coronary lesions,Gensini score,and the number of multivessel coronary artery lesions in high expression group were greater than those in normal expression group(all P<0.05).Spearman correlation analysis showed that Lp-PLA2 was positively correlated with Gensini score,hs-CRP,LDL-C and D-dimer(r=0.187,0.196,0.323,0.075,all P<0.05).Multivariate Logistic regression analysis showed that TC(OR:0.442,95%CI:0.256-0.694,P<0.05),LDL-C(OR:5.656,95%CI:2.944-10.868,P<0.05),hs-CRP(OR:1.127,95%CI:1.082-1.174,P<0.05),D-dimer(OR:1.310,95%CI:1.075-1.596,P<0.05)were related factors of Lp-PLA2.The incidence of cardiovascular adverse events during a 12-month follow-up in the high expression group was higher than that in the normal expression group(18.35%vs.12.50%,P<0.05).Conclusion:The expression of Lp-PLA2 is correlated with LDL-C,hs-CRP and D-dimer,and closely related to the degree of coronary lesions and prognosis in patients with AMI.