血清sdLDL-C、Lp-PLA2及hs-CRP联合检测对冠心病的诊断价值

Diagnostic value of combined serum sdLDL-C,Lp-PLA2 and hs-CRP assay for coronary heart disease

目的探讨血清小而密低密度脂蛋白胆固醇(sdLDL-C)、脂蛋白相关磷脂酶A2(Lp-PLA2)、超敏C反应蛋白(hs-CRP)对冠状动脉粥样硬化性心脏病(简称冠心病)的诊断价值,以期为临床早期筛查诊断、评估病情提供参考。方法选取180例冠心病患者作为观察组,观察组因不同病情不同分为稳定型心绞痛(stable angina pectoris,SAP)组72例、不稳定型心绞痛(unstable angina pectoris,UAP)组58例、急性心肌梗死(acute myocardial infarction,AMI)组50例,另选取同期90例健康体检者作为对照组。比较观察组和对照组受试者,SAP组(72例)、UAP组(58例)和AMI组(50例)患者,冠脉病变程度不同患者入院时的血清sdLDL-C、Lp-PLA2、hs-CRP水平。分析上述血清指标水平与冠心病病情、冠脉病变程度的相关性,并分析其联合检测对冠心病的诊断价值。结果观察组患者入院时血清sdLDL-C、Lp-PLA2、hs-CRP水平高于对照组,差异有统计学意义(P<0.05);不同病情患者入院时血清sdLDL-C、Lp-PLA2、hs-CRP水平比较,AMI组>UAP组>SAP组,差异有统计学意义(P<0.05);Ⅳ级患者入院时血清sdLDL-C、Lp-PLA2、hs-CRP水平高于冠脉病变Ⅲ级患者,差异有统计学意义(P<0.05)。入院时血清sdLDL-C、Lp-PLA2、hs-CRP水平与冠心病病情、冠脉病变程度呈正相关(P<0.05);经受试者工作特征(ROC)曲线分析显示,入院时血清sdLDL-C、Lp-PLA2、hs-CRP水平对冠心病诊断曲线下面积(AUC)分别为0.795、0.856、0.832,各指标联合诊断AUC为0.927,优于单一指标诊断。结论血清sdLDL-C、Lp-PLA2、hs-CRP水平可用于冠心病诊断,为临床早期病情评估提供依据,以针对性制定相应干预方案,改善预后。

Objective To investigate the diagnostic value of serum small and dense low-density lipoprotein cholesterol(sdLDL-C),lipoprotein-associated phospholipase A2(Lp-PLA2),and ultrasensitive C-reactive protein(hs-CRP)for coronary artery disease,with a view to providing reference for early clinical screening and diagnosis and assessment of the disease.Methods One hundred and eighty patients with coronary heart disease who visited our hospital from September 2021 to September 2022 were selected as the study group,and another 90 patients with healthy physical examination in the same period were selected as the reference group.The levels of serum sdLDL-C,Lp-PLA2 and hs-CRP at the time of admission in the study group,the reference group and the study group with different conditions and degree of coronary lesions were compared,and the correlation between the levels of the above serum indexes and the condition of coronary heart disease and the degree of coronary lesions was analyzed,and the diagnostic value of their combined testing on coronary heart disease was analyzed.Results Compared with the reference group,serum sdLDL-C,Lp-PLA2,and hs-CRP levels were higher in the study group at admission(P<0.05);serum sdLDL-C,Lp-PLA2,and hs-CRP levels were higher in patients with different conditions at admission:AMI group>UAP group>SAP group(P<0.05).Serum sdLDL-C,Lp-PLA2,and hs-CRP levels at admission were higher in patients with grade IV compared with those with grade III coronary artery lesions(P<0.05);serum sdLDL-C,Lp-PLA2,and hs-CRP levels at admission were positively correlated with coronary artery disease condition and degree of coronary artery lesions(P<0.05).The ROC curve analysis showed that the AUC of serum sdLDL-C,Lp-PLA2,and hs-CRP levels at admission for the diagnosis of coronary heart disease was 0.795,0.856,and 0.832,respectively,and the AUC of the combined diagnosis of each index was 0.927,which was better than that of the single index.Conclusion Serum sdLDL-C,Lp-PLA2,and hs-CRP levels can be used in the diagnosis of coronary artery disease to provide a basis for early clinical assessment of the disease in order to target the appropriate intervention programs and improve prognosis.