无症状性颈动脉狭窄病人支架成形术前后Lp-PLA2动态变化及其与相关危险因素的关系

DYNAMIC CHANGES OF LP-PLA 2 BEFORE AND AFTER STENTING FOR ASYMPTOMATIC CAROTID ARTERY STENOSIS

目的观察无症状性颈动脉狭窄(ACAS)病人行支架成形术前后血浆脂蛋白相关磷脂酶A_(2)(Lp-PLA_(2))活性变化,并分析Lp-PLA_(2)与低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、超敏C反应蛋白(hs-CRP)的相关性。方法依据所实施的介入手术治疗方式,将在我科住院的ACAS病人分为单纯造影组37例、支架成形组54例、球囊扩张组28例,以同期我院体检中心的55例健康体检者作为健康对照组。采用双抗体夹心法检测行介入手术治疗3组术前以及术后2h内、1d、3d、15d的血浆Lp-PLA_(2)活性;采用Pearson相关分析法分析支架成形组Lp-PLA_(2)与LDL、HDL、hs-CRP的相关性。结果术前,单纯造影组、支架成形组、球囊扩张组病人的血浆Lp-PLA_(2)活性均显著高于健康对照组(F=35.06,P<0.05);而行介入手术治疗3组组间比较差异无统计学意义(P>0.05)。支架成形组、球囊扩张组术后1、3d的血浆Lp-PLA_(2)活性均较同组术前升高,术后15d较术前下降(F_(时间)=212.96,P<0.05);支架成形组、球囊扩张组术后1、3、15d时的血浆Lp-PLA_(2)活性均较单纯造影组明显升高(F_(组间)=8.83,P<0.05),支架成形组与球囊扩张组比较则差异无显著性(P>0.05)。支架成形组病人血浆Lp-PLA_(2)活性与LDL、hs-CRP水平呈正相关(r=0.72、0.66,P<0.05),与HDL水平呈负相关(r=-0.63,P<0.05)。结论在ACAS病人支架成形术后,血浆Lp-PLA2活性出现一过性增高。且Lp-PLA_(2)活性与LDL、hs-CRP呈负相关,与HDL呈正相关。

Objective To observe the activity of plasma lipoprotein-associated phospholipase A_(2)(Lp-PLA_(2))before and after stenting for asymptomatic carotid artery stenosis(ACAS),and to analyze the correlations of Lp-PLA_(2) with low-density lipoprotein(LDL),high-density lipoprotein(HDL),and high-sensitivity C-reactive protein(hs-CRP).Methods According to the surgery procedures,patients with ACAS were divided into simple radiography group(37 cases),stenting group(54 cases),and balloon angioplasty group(28 cases),with 55 healthy subjects in the physical examination center of the hospital during the study period as the control group.Plasma Lp-PLA_(2) activity was determined by the double antibody sandwich method before and 2 h,1 d,3 d,and 15 d after surgeries.A Pearson correlation analysis was used to assess the correlations of Lp-PLA_(2) with LDL,HDL,and hs-CRP in the stenting group.Results Before surgery,the activities of Lp-PLA_(2) in simple radiography group,stenting group,and balloon angioplasty group were higher than that of control group(F=35.06,P<0.05),with no significant differences between the three treatment groups.The activities of Lp-PLA_(2) in stenting group and balloon angioplasty group at 1 and 3 d after surgery were higher than those before surgery but the activity at 15 d after surgery was lower than that observed preoperatively(F_(time)=212.96,P<0.05).The activities of plasma Lp-PLA_(2) in stenting group and balloon angioplasty group at 1,3,and 15 d after surgery were significantly higher than that in simple radiography group(F_(between-group)=8.83,P<0.05).There were no significant differences between the stenting group and the balloon angioplasty group.In the stenting group,plasma Lp-PLA_(2) activity was positively correlated with LDL and hs-CRP(r=0.72,0.66;P<0.05)but negatively correlated with HDL(r=-0.63,P<0.05).Conclusion After stenting for asymptomatic carotid artery stenosis,plasma Lp-PLA_(2) activity increases transiently.Lp-PLA_(2) activity is positively correlated with LDL and hs-CRP but negatively correlated with HDL.