血清磷脂酶A2及超敏C-反应蛋白水平检测冠状动脉粥样硬化易损斑块的特异性分析

Specificity analysis of serum phospholipase A2 and hypersensitive C-reactive protein levels for detecting vulnerable atherosclerotic plaques in patients with coronary heart disease

目的探讨通过血清磷脂酶(Lp-PL)A2及超敏C-反应蛋白(hs-CRP)水平检测冠状动脉粥样硬化性心脏病(CHD)患者冠状动脉粥样硬化易损斑块的特异性。方法选取2019年1月至2020年1月南方医科大学南海医院收治的56例CHD患者为研究对象,根据患者血管内超声及冠状动脉造影检查结果,将其分为易损斑块组(n=26)及稳定斑块组(n=30),另选取同期行健康体检者30名作为对照组,对其血清Lp-PLA2及hs-CRP进行检测,评价血清Lp-PLA2及hs-CRP的灵敏度、特异度等诊断性能,并利用logistic多元回归模型分析血清Lp-PLA2及hs-CRP与斑块特征的相关性,以评价标志物在易损斑块早期发现和干预中的应用价值。结果易损斑块组的血清Lp-PLA2及hs-CRP水平显著高于稳定斑块组及对照组(P<0.05);血清Lp-PLA2及hs-CRP联合检测的敏感度及特异度明显高于任何单一筛查结果(P<0.05);血清Lp-PLA2及hs-CRP与斑块特征存在密切关联,血清Lp-PLA2及hs-CRP水平高低与斑块的稳定性呈负相关(P<0.05)。结论对CHD患者的血清Lp-PLA2及hs-CRP水平进行检测,可使得冠状动脉粥样硬化易损斑块被更好地检测出,为疾病治疗方案的确定及评价疾病的治疗效果与预后情况提供新的思路。

Objective To investigate the specificity of serum phospholipase[lipoprotein-associated phospholipase(Lp-PL)]A2 and hypersensitive C-reactive protein(hs-CRP)levels for detecting vulnerable atherosclerotic plaques in patients with coronary heart disease(CHD).Methods A total of 56 patients with CHD admitted to Nanhai Hospital of Southern Medical University from January 2019 to January 2020 were selected as the study subjects.They were divided into the vulnerable plaque group(n=26)and the stable plaque group(n=30)according to the results of intravascular ultrasound and coronary angiography,and 30 patients who underwent health check-ups at the same period were selected as the control group.The Lp-PLA2 and hs-CRP levels of all the subjects were detected,and the sensitivity,specificity and other diagnostic efficiency of serum Lp-PLA2 and hs-CRP were evaluated.In addition,the correlation between serum Lp-PLA2 and hs-CRP and plaque characteristics was analyzed by logistic multiple regression model,so as to evaluate the application value of markers in the early detection and intervention of vulnerable plaques.Results The serum Lp-PLA2 and hs-CRP levels in the vulnerable plaque group were significantly higher than those in the stable plaque group and those in the control group(P<0.05).The sensitivity and specificity of the combined detection of serum Lp-PLA2 and hs-CRP were significantly higher than those of any single screening result(P<0.05).There was a close correlation between serum Lp-PLA2 and hs-CRP and plaque characteristics,and the high and lower levels of serum Lp-PLA2 and hs-CRP were negatively correlated with plaque stability(P<0.05).Conclusion The detection of Lp-PLA2 and hs-CRP levels in patients with CHD enables sound detection of vulnerable atherosclerotic plaques,and provides new ideas for the determination of disease treatment plans and evaluation of disease treatment effects and prognosis.