血清脂蛋白相关磷脂酶A2及超敏C反应蛋白与急性冠脉综合征的关系

Relationship between lipoprotein associated phospholipase A2 or hs-CRP and acute coronary syndrome

目的探讨脂蛋白相关磷脂酶(Lp-PL)A2及超敏C反应蛋白(hs-CRP)与急性冠脉综合征(ACS)的发生及冠脉病变严重程度的相关性。方法2017年6月~2018年10月于西安交通大学医学院第一附属医院心脏内科住院并行冠脉造影(CAG)确诊为ACS的患者373例,另外选择同期CAG结果正常的107例患者作为非冠心病组。将ACS患者根据冠脉Gensini积分的中位数进一步分为两组,定义为轻度病变组及重度病变组;根据冠脉病变支数分为三组,分别为单支病变组、双支病变组、三支病变组。结果与非冠心病组相比,ACS组患者的血清Lp-PLA2和炎症指标hs-CRP明显升高,差异均有统计学意义。冠脉重度病变组的血清Lp-PLA2和hs-CRP水平高于冠脉轻度病变组,差异均有统计学意义(P<0.01)。随着冠心病患者病变累及支数的增多,Lp-PLA2水平和Gensini积分也逐渐增加。相关分析显示Lp-PLA2、hs-CRP水平与Gensini积分呈正相关。多因素Logistic回归分析显示,hs-CRP和Lp-PLA2是冠脉病变重度病变的独立危险因素。利用ROC曲线显示Lp-PLA2诊断冠心病的曲线下面积为0.836(95%CI:0.802~0.869)。当Lp-PLA2诊断临界值取129.03 ng/ml时,其诊断效能最高,灵敏度为64.1%,特异度为96.6%。结论血清Lp-PLA2和hs-CRP与ACS冠状动脉病变严重程度成正相关,是冠脉严重病变的独立危险因素。血清Lp-PLA2对ACS有一定的诊断价值。

AIM To investigate the relationship between serum lipoprotein associated phospholipase A2(Lp-PLA2)level or high-sensitivity c-reactive protein(hs-CRP)and the severity of coronary artery stenosis in patients with acute coronary syndrome(ACS).METHODS A total of 480 patients who had undergone coronary angiography in our hospital from June 2017 to October 2018 were enrolled into this study and analyzed retrospectively.Three hundred and seventy-three patients were diagnosed with ACS and they were divided into two groups according to the median of their Gensini score.The two groups were defined as mild lesions group and severe lesions group.Additional 107 non-CAD hospitalized patients were selected as the control group.RESULTS Serum Lp-PLA2 and hs-CRP level in the ACS group were significantly higher than those in the control group and the differences were statistically signi-ficant(P<0.01).Serum Lp-PLA2 and hs-CRP levels in the severe lesion group were higher than those in the mild lesion group and the difference was statistically significant(P<0.01).The serum level of Lp-PLA2 and Gensini score in patients with acute coronary syndrome increased gradually with the increase of the number of lesions and the degree of lesions and the difference was significant(P<0.01).The correlation analysis showed that the levels of serum Lp-PLA2 and hs-CRP were significantly positively correlated with Gensini score.Multivariate logistic regression analysis indicated that the levels of serum Lp-PLA2 and hs-CRP were independent risk factors of ACS.The receiver operating characteristic curve showed that the area under the curve of Lp-PLA2 for the diagnosis of ACS was 0.836(95%CI:0.802~0.869).Lp-PLA2 predicted ACS with a sensitivity of 64.1%and specificity of 96.6%.CONCLUSION The levels of serum Lp-PLA2 and hs-CRP are positively associated with the severity of coronary artery stenosis in ACS patients.The levels of serum Lp-PLA2 and hs-CRP are independent risk factors of severe ACS.Lp-PLA2 has a certain predictive value for ACS.