血浆脂蛋白相关磷脂酶A2等因子水平与冠心病高危患者体外反搏疗效的关系

Relationships of indicators such as level of plasma lipoprotein-associated phospholipase A2 with effect of extracorporeal counterpulsation therapy in high-risk patients with coronary heart disease

目的探讨冠心病高危人群血浆脂蛋白相关磷脂酶A2(Lp-PLA2)、可溶性脂蛋白受体相关蛋白1(sLRP-1)、脂肪素(visfatin)的变化及其对增强型体外反搏治疗结局的影响。方法选取94例冠心病高危患者纳入观察组,另选取同期健康体检者80例纳入对照组,比较2组血浆Lp-PLA2、sLRP-1、visfatin、血脂指标[甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]水平和心脏彩超检查结果[左室射血分数(LVEF)、左室短轴缩短率(FS)、左室舒张末期内径(LVDd)],评价血清Lp-PLA2、sLRP-1、visfatin对冠心病高危的诊断价值。根据增强型体外反搏治疗结局将观察组患者分为缓解组和未缓解组,分析血浆Lp-PLA2、sLRP-1、visfatin与治疗结局的关系。结果观察组血浆Lp-PLA2、sLRP-1、visfatin水平均高于对照组,差异有统计学意义(P<0.05);观察组血浆TC、TG水平高于对照组,HDL-C水平低于对照组,差异有统计学意义(P<0.05);观察组FS高于对照组,LVDd大于对照组,LVEF低于对照组,差异有统计学意义(P<0.05)。受试者工作特征(ROC)曲线显示,血浆Lp-PLA2预测冠心病高危的曲线下面积(AUC)为0.669,最佳临界值为47.36μg/L;血清sLRP-1预测冠心病高危的AUC为0.957,最佳临界值为2.58μg/mL;血清visfatin预测冠心病高危的AUC为0.932,最佳临界值为53.46 ng/mL。未缓解组血浆Lp-PLA2、sLRP-1、visfatin水平均高于缓解组,差异有统计学意义(P<0.05)。Logistic回归方程显示,血浆Lp-PLA2、sLRP-1、visfatin均与治疗结局呈显著相关性(P<0.05)。结论血浆Lp-PLA2、sLRP-1、visfatin水平高的冠心病高危患者,其对增强型体外反搏治疗反应较差。

Objective To study changes of plasma lipoprotein associated phospholipase A2(Lp-PLA2), soluble lipoprotein receptor-associated protein 1(sLRP-1), visfatin in high-risk patients with coronary heart disease and their effects on the outcomes of enhanced external counterpulsation therapy. Methods A total of 94 patients with high risk of coronary heart disease admitted to our hospital were selected as observation group, and 80 healthy subjects in our hospital during the same period were selected as control group. Plasma Lp-PLA2, sLRP-1, visfatin, blood lipid indicators[triglyceride(TG), total cholesterol(TC), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C)] and cardiac color Doppler ultrasound results [left ventricular ejection fraction(LVEF), left ventricular fractional shortening(FS), left ventricular end-diastolic diameter(LVDd)] were compared, and the diagnostic value of serum Lp-PLA2, sLRP-1 and visfatin in patients with high risk of coronary heart disease was evaluated. The observation group was divided into remission groupand non-remission group according to the outcome of enhanced external counterpulsation therapy,and the relationships of plasma Lp-PLA2,s LRP-1,visfatin with treatment outcomes were analyzed.Results Plasma Lp-PLA2,s LRP-1 and visfatin levels in the observation group were significantly higher than those in the control group( P < 0. 05). The plasma TC and TG levels in the experimental group were higher than those in the control group,while HDL-C level was lower than that of the control group( P < 0. 05). The level of FS in experimental group was significantly higher than those in control group,LVDd was larger,while LVEF was significantly lower than that in the control group( P < 0. 05). Receiver operating characteristic( ROC) curve results showed that the area under the curve( AUC) of plasma Lp-PLA2 in predicting the high risk of coronary heart disease was 0. 669,and the optimal critical value was 47. 36 μg/L. The AUC of serum s LRP-1 in predicting the high risk of coronary heart disease was 0. 957,and the optimal critical value was 2. 58 μg/m L. The AUC of serum visfatin in predicting the high risk of coronary heart disease was 0. 932,and the optimal critical value was 53. 46 ng/m L( P < 0. 05). Plasma Lp-PLA2,s LRP-1 and visfatin levels in nonremission group were significantly higher than those in the remission group( P < 0. 05). Logistic regression equation showed that plasma Lp-PLA2,s LRP-1 and visfatin were positively correlated with treatment outcomes( P < 0. 05). Conclusion Patients with higher plasma levels of Lp-PLA2,s LRP-1 and visfatin have poor response to enhanced external counterpulsation therapy.