冠心病患者血清Lp-PLA2、suPAR、apoM水平与病变程度的相关性

Correlation of serum Lp-PLA2,suPAR,apoM levels with the severity in patients with coronary heart disease

目的探讨冠心病患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)、可溶性尿激酶型纤溶酶原激活物受体(suPAR)及载脂蛋白M(apoM)与病变程度的关系。方法186例冠心病患者作为病例组[其中急性冠脉综合征(ACS)患者73例作为ACS组、稳定性心绞痛(SAP)患者113例作为SAP组,再根据冠脉病变支数将患者分为单支病变组(n=66)、双支病变组(n=65)及多支病变组(n=55),又根据患者病情严重程度分为轻度组(n=78)、中度组(n=68)及重度组(n=40)],选择100名健康体检者为对照组;采用酶联免疫吸附法测定被检者入院或体检当日血清Lp-PLA2、suPAR及apoM水平,比较SAP组和ACS组患者与对照组、不同冠脉病变支数患者与对照组及不同病变程度患者与对照组血清Lp-PLA2、suPAR及apoM水平;采用Spearman相关性分析3项血清学指标与冠脉病变支数的相关性,Pearson相关性分析3项血清学指标与Gensini评分的相关性,采用ROC受试者特征工作曲线(ROC)下面积(AUC)分析3项血清学指标对冠脉病变严重程度的评估价值。结果血清Lp-PLA2、suPAR水平比较,ACS组>SAP组>对照组,多支病变组>双支病变组>单支病变组>对照组,重度组>中度组>轻度组>对照组,差异有统计学意义(P<0.05或<0.01);血清apoM水平比较,ACS组<SAP组<对照组,多支病变组<双支病变组<单支病变组<对照组,重度组<中度组<轻度组<对照组,差异有统计学意义(P<0.05或<0.01);Spearman相关性分析显示,血清Lp-PLA2、suPAR与冠脉病变支数呈正相关,apoM与冠脉病变支数呈负相关(P<0.05);Pearson相关性分析示,血清Lp-PLA2、suPAR与Gensini评分呈正相关,apoM与Gensini评分呈负相关(P<0.05);血清Lp-PLA2、suPAR、apoM诊断ACS的AUC分别为0.727、0.689、0.681,3项指标联合评估的AUC为0.762;血清Lp-PLA2、suPAR、apoM评估中重度冠心病患者的AUC分别为0.814、0.779、0.792,3者联合评估的AUC为0.904。结论冠心病患者存在血清Lp-PLA2、suPAR及apoM水平的变化,且其水平与病变程度相关。

Objective To investigate the relationship between serum lipoprotein-related phospholipase A2(Lp-PLA2),soluble urokinase-type plasminogen activator receptor(suPAR),apolipoprotein M(apoM)and pathological changes in patients with coronary heart disease(CHD).Methods One hundred and eighty-six CHD patients were chosen as case groups(73 acute coronary syndrome(ACS)patients as ACS group,113 stable angina pectoris patients as SAP group,single diseased vessel group(n=66),dual diseased vessels group(n=65)and multi diseased vessel group(n=55)were chosen according to number of diseased coronary vessels;subjects were further divided into mild symptom group(n=78),moderate symptom group(n=68)and advanced symptom group(n=40)).100 healthy people received physical check were chosen as control group.The levels of serum Lp-PLA2,suPAR,and apoM were detected by enzyme-linked immunosorbent assay(ELISA).Comparing levels of serum Lp-PLA2,suPAR,and apoM of SAP group and ACS group with control group,varied diseased vessels group with control group,varied pathological changes groups with controlled groups.Adopting Spearman to analyze correlation between 3 serum markers and coronary diseased vessels,adopting Pearson to analyze correlation between 3 serum markers and Gensini scores,adopting ROC to calculate area under the curve(AUC)to analyze evaluation value of 3 serum markers on coronary lesion severity.Results Levels of serum Lp-PLA2 and suPAR comparison showed that acute coronary syndrome(ACS)group>stable angina pectoris(SAP)group>control group,multi diseased vessel group>dual diseased vessels group>single diseased vessel group>control group,advanced symptom group>moderate symptom group>mild symptom group>control group,differences were statistically significant(P<0.05).Concerning serum apoM level comparison,ACS group<SAP group<control group,multi diseased vessel group<dual diseased vessels group<single diseased vessel group<control group,advanced symptom group<moderate symptom group<mild symptom group<control group,differences were statistically significant(P<0.05).Spearman correlation analysis showed that serum Lp-PLA2 and suPAR were positively correlated with the number of coronary disease vessels,while apoM was negatively correlated with it(P<0.05).Pearson correlation analysis showed that serum Lp-PLA2 and suPAR were positively correlated with Gensini score,while apoM was negatively correlated with it(P<0.05).AUC values of serum Lp-PLA2,suPAR,apoM,and their combination in the diagnosis of ACS were 0.727,0.689,0.681,and 0.762 respectively.AUC values of serum Lp-PLA2,suPAR,apoM,and their combination for evaluating patients with moderate to advanced CHD were 0.814,0.779,0.792,and 0.904,respectively.Conclusion There are changes in levels of serum Lp-PLA2,suPAR,and apoM in CHD patients,and such levels are related to lesion degrees.