急性冠脉综合征患者Lp-PLA2、FFA、Fib水平的变化及意义

Changes and significance of Lp-PLA2,FFA,Fib levels in patients with acute coronary syndrome

目的探讨急性冠脉综合征(acute coronary syndrome,ACS)患者脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)、游离脂肪酸(free fatty acid,FFA)、纤维蛋白原(fibrinogen,Fib)水平的变化及意义。方法选取2018年3月至2020年9月廊坊市第四人民医院冠心病患者246例(冠心病组),并将其分为以下亚组:ACS亚组、稳定型心绞痛(stable angina pectoris,SA)亚组;轻度病变亚组、中度病变亚组、重度病变亚组;单支病变亚组、双支病变亚组、三支病变亚组。另选取同期因胸痛入院并排除冠心病的患者30例作为非冠心病组。分别采用速率法、氧化酶法、凝固法检测各组患者血清Lp-PLA2、FFA、Fib水平。结果与非冠心病组和SA亚组相比,ACS亚组Lp-PLA2、FFA、Fib水平明显升高,差异有统计学意义(F值分别为8.73、14.65、10.98,P值均<0.05)。与中轻度病变亚组患者相比,重度病变亚组患者Lp-PLA2、FFA、Fib水平较明显升高,差异有统计学意义(F值分别为8.69、13.06、9.38,P值均<0.05)。与单支和双支病变亚组患者相比,三支病变亚组患者Lp-PLA2、FFA、Fib水平较明显升高,差异有统计学意义(F值分别为7.21、20.83、9.058,P值均<0.05)。与不稳定型心绞痛(unstable angina pectoris,UA)和急性非ST段抬高性心肌梗死患者(non-ST-segment elevation myocardial infarction,NSTEMI)患者相比,急性ST段抬高性心肌梗死患者(ST-segment elevation myocardial infarction,STEMI)患者Lp-PLA2、FFA、Fib水平明显升高,全球急性冠状动脉事件注册评分(global registry of acute coronary events,GRACE)评分明显更高,差异有统计学意义(F值分别为9.54、5.61、9.05、6.27,P值均<0.05)。双变量线性相关性分析结果显示,不同分型ACS患者Lp-PLA2、FFA、Fib水平均与GRACE评分呈显著正相关(rLp-PLA2=0.69、0.80、0.89,rFFA=0.45、0.50、0.70,rFib=0.53、0.76、0.84,P值均<0.05)。结论Lp-PLA2、FFA、Fib与ACS患者的病情严重程度有关,高水平Lp-PLA2、FFA、Fib标志着病情的进一步加重。

Objective To study the changes and significance of lipoprotein-related phospholipase A2(Lp-PLA2),free fatty acid(FFA),fibrinogen(Fib)levels in patients with acute coronary syndrome(ACS).Methods Total of 246 patients with coronary heart disease treated in Fourth People’s Hospital of Langfang City from March 2018 to September 2020 were selected(coronary heart disease group).The coronary heart disease group was divided into the following subgroups:ACS subgroup and stable angina pectoris(SA)subgroup;mild lesion subgroup,moderate lesion subgroup and severe lesion subgroup;single vessel lesion subgroup,double vessel lesion subgroup and three vessel lesion subgroup.In addition,30 patients with chest pain and excluding coronary heart disease were selected as the non coronary heart disease group.The serum levels of Lp-PLA2,FFA and Fib were measured by rate method,oxidase method and coagulation method.Results Compared with the non coronary heart disease group and the SA subgroup,the levels of Lp-PLA2,FFA and Fib in the ACS subgroup were significantly increased(F values were 8.73,14.65 and 10.98 respectively,all P values<0.05).Compared with those in the moderate and mild lesion subgroup,the levels of Lp-PLA2,FFA and Fib in the severe lesion subgroup were significantly increased(F values were 8.69,13.06 and 9.38 respectively,all P values<0.05).Compared with those in single and double vessel lesion subgroup,the levels of Lp-PLA2,FFA and Fib were significantly increased in three vessel lesion subgroup(F values were 7.21,20.83 and 9.058,respectively,all P values<0.05).Compared with unstable angina pectoris(UA)and non-ST-segment elevation myocardial infarction(NSTEMI)patients,The levels of Lp-PLA2,FFA and Fib were significantly higher,and the global registry of acute coronary events(GRACE)scores were significantly higher in ST-segment elevation myocardial infarction(STEMI)patients(F values were 9.54,5.61,9.05 and 6.27 respectively,all P values<0.05).The results of bivariate linear correlation analysis showed that Lp-PLA2,FFA and Fib levels were significantly positively correlated with GRACE score in different ACS patients(rLp-PLA2=0.69,0.80,0.89,rFFA=0.45,0.50,0.70,rFib=0.53,0.76,0.84,all P values<0.05).Conclusion Lp-PLA2,FFA and Fib are related to the severity of the disease in ACS patients,and high levels of Lp-PLA2,FFA,Fib indicate the further aggravation of the disease.