老年冠心病合并衰弱综合征患者脂蛋白相关磷脂 酶A2、基质金属蛋白酶-9、非酯化脂肪酸水平变化及其临床意义

Changes and clinical significance of lipoprotein associated phospholipase A2,matrix metalloproteinase-9 and non-esterified fatty acid in elderly patients with coronary heart disease and frailty syndrome

目的探讨老年冠心病合并衰弱综合征患者脂蛋白相关磷脂酶A2(lipoprotein associated phospholipase A2,Lp-PLA2)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)、非酯化脂肪酸(non-esterified fatty acid,NEFA)水平变化及其临床意义。方法选取2015年1月至2019年6月连云港市第一人民医院收治的225例老年冠心病患者为研究对象,根据临床衰弱量表(clinical frailty scale,CFS)评分将其分为观察组(CFS评分≥5分,53例)和对照组(CFS评分<5分,172例),比较两组患者的临床特点和血清Lp-PLA2、MMP-9、NEFA水平,采用多因素Logistic回归分析探讨老年冠心病患者合并衰弱综合征的独立危险因素,并分析观察组患者血清Lp-PLA2、MMP-9、NEFA水平与Gensini积分、Grous积分的相关性。结果观察组患者年龄、合并糖尿病、慢性肾功能不全、慢性阻塞性肺疾病者和重度冠状动脉病变、颈动脉狭窄者占比及血清脑钠肽、C反应蛋白、Lp-PLA2、MMP-9、NEFA水平均显著高于对照组(均P<0.05),白蛋白水平显著低于对照组(P<0.05)。多因素Logistic回归分析结果显示,年龄、重度冠状动脉病变、血清脑钠肽、Lp-PLA2、MMP-9、NEFA水平均是老年冠心病患者合并衰弱综合征的独立危险因素(均P<0.05)。观察组患者血清Lp-PLA2、MMP-9、NEFA水平均与Gensini积分、Grous积分均呈显著正相关(均P<0.05)。结论老年冠心病合并衰弱综合征患者血清Lp-PLA2、MMP-9、NEFA水平均显著升高,且与衰弱综合征的发生有关。

Objective To investigate the changes and clinical significance of lipoprotein associated phospholipase A2(Lp-PLA2),matrix metalloproteinase-9(MMP-9)and non-esterified fatty acid(NEFA)in elderly patients with coronary heart disease and frailty syndrome.Method Two hundred and twenty-five elderly patients with coronary heart disease admitted to the First People's Hospital of Lianyungang from January 2015 to June 2019 were enrolled for the research.According to clinical frailty scale(CFS)score,those patients were divided into observation group(CFS score≥5,53 cases)and control group(CFS score<5,172 cases).The clinical characteristics,Lp-PLA2,MMP-9 and NEFA levels were compared between the two groups.The independent risk factors of fissured syndrome in elderly patients with coronary heart disease were investigated by multiple Logistic regression analysis,and the correlation between serum Lp-PLA2,MMP-9 and NEFA levels and Gensini score and Grous score in observation group was analyzed.Result In observation group,age,the proportion of diabetes,chronic renal insufficiency,chronic obstructive pulmonary disease,severe coronary artery disease and carotid artery stenosis,serum levels of brain natriuretic peptide,C reactive protein,Lp-PLA2,MMP-9 and NEFA were significantly higher than those in control group(all P<0.05),and albumin level was significantly lower than that in control group(P<0.05).Multivariate Logistic regression analysis showed that age,severe coronary lesions,brain natriuretic peptide,Lp-PLA2,MMP-9 and NEFA levels were the independent predictors of frailty syndrome in elderly patients with coronary heart disease(all P<0.05).The levels of Lp-PLA2,MMP-9 and NEFA in observation group were significantly positively correlated with Gensini score and Grous score(all P<0.05).Conclusion The Lp-PLA2,MMP-9 and NEFA levels of elderly patients with coronary heart disease and frailty syndrome significantly increased,and they may be related to the occurrence of asthenia syndrome and involved in the atherosclerotic process of coronary artery and carotid artery.