外周血外泌体Lp-PLA2的早期检测对高风险评分冠心病患者心肌梗死发生的预测作用

The Early Detection of Peripheral Blood Extracellular Vesicle Lp-PLA2 inPredicting the Occurrence of Myocardial Infarction in High-riskScoring Coronary Heart Disease Patients

目的 观察外泌体LP-PLA2在不同程度冠心病患者中的表达及其对发生心肌梗死的预测价值。方法 选取我院2019年7月至2021年7月心内科患者200例,将患者分为3组:49例冠状动脉无明显狭窄病变(对照组);心绞痛96例(AP组),包括稳定型心绞痛(SA组)43例及不稳定型心绞痛(UA组)53例;急性心肌梗死55例(AMI组)。采用外泌体试剂盒提取血清中外泌体,使用ELISA方法检测血清外泌体中LP-PLA2以及血清中C反应蛋白(CRP)的表达。比较3组患者基线资料(年龄、高血压病史、吸烟、代谢评分、心力衰竭病史、他汀类药物用药史和血清HDL胆固醇水平)以及LP-PLA2和hs-CRP的表达情况,采用单变量及多变量逻辑分析各因素与AMI发生的相关性;通过ROC分析,确定血清外泌体Lp-PLA2诊断AMI的灵敏度和特异性。结果 (1)3组患者在年龄、高血压病史、吸烟史、代谢评分、是否伴有心力衰竭病史、他汀类药物使用史(%)和血清HDL胆固醇水平方面差异无统计学意义(P>0.05)。但3组患者Lp-PLA2水平和hs-CRP水平差异存在统计学意义(P<0.05);(2)AMI组的Lp-PLA2水平显著高于AP组和对照组,UA组Lp-PLA2水平明显高于SA组,差异均具有统计学意义。此外,AMI组的血清hs-CRP水平显著高于对照组,AMI组的血清hs-CRP水平显著高于AP组,但后者的差异无统计学意义。在3组患者中,Lp-PLA2和hs-CRP水平之间的关系均无统计学意义;(3)采用单变量Logistic回归分析,男性、老年、Lp-PLA2水平、hs-CRP水平、吸烟和心力衰竭与AMI显著相关。多因素Logistic回归分析显示,老年和Lp-PLA2水平与AMI显著相关。Lp-PLA2水平与AMI的患病率相关,这种相关性具有统计学意义;(4)ROC分析显示血清外泌体Lp-PLA2水平对诊断AMI的灵敏度和特异性均高于血清hs-CRP水平。结论 血清外泌体LP-PLA2在冠心病患者发生心肌梗死后显著高表达,并与血管病变程度呈正相关,表明血清外泌体LP-PLA2对冠心病患者并发心肌梗死具有预测作用。

Objective To observe the expression of extracellular vesicle LP-PLA2 in patients with various degrees of coronary heart disease and its predictive value for the occurrence of myocardial infarction.Methods 200 patients from the Cardiology Department of our hospital from July,2019 to July,2021 were selected and divided into three groups:49 patients without obvious coronary artery stenosis(control group),96 cases of angina pectoris(AP group),including 43 cases of stable angina pectoris(SA group)and 53 cases of unstable angina pectoris(UA group),as well as 55 cases of acute myocardial infarction(AMI group).Serum exosomes were extracted using an exosomes kit,and expressions of LP-PLA2 and C-reactive protein(CRP)in serum exosomes were detected using ELISA method.We compared the baseline data among these three groups of patients(age,history of hypertension,smoking,metabolic score,history of heart failure,history of statin medication,and serum HDL cholesterol levels),as well as expressions of LP-PLA2 and hs CRP.We used univariate and multivariate logistic analysis to analyze the correlation between each factor and the occurrence of AMI;We then determined the sensitivity and specificity of serum extracellular vesicle Lp-PLA2 in diagnosing AMI through ROC analysis.Results(1)There were no significant differences among the three groups in age,hypertension history,smoking history,metabolic score,history of heart failure,statin use history(%)and serum HDL cholesterol level(P>0.05),while levels of Lp-PLA2 and hs-CRP among these three groups were different(P<0.05).(2)The level of Lp PLA2 in the AMI group was significantly higher than that in the AP group and control group,while the level of Lp PLA2 in the UA group was significantly higher than that in the SA group.In addition,the serum hs CRP concentration in the AMI group was significantly higher than that in the control group,and the serum hs CRP concentration in the AMI group was significantly higher than that in the AP group,but the difference in the latter was not statistically significant.The relationship between Lp PLA2 and hs CRP levels was not statistically significant among the three groups of patients.(3)Univariate logistic regression analysis showed that there was a significant correlation between male,elderly,Lp-PLA2 levels,hs CRP levels,smoking,and heart failure with AMI.Multivariate logistic regression analysis identified a significant correlation between elderly and Lp-PLA2 levels and AMI.The level of Lp-PLA2 was correlated with the prevalence of AMI,and this correlation was statistically significant.(4)ROC analysis showed that the sensitivity and specificity of serum extracellular vesicle Lp-PLA2 levels for diagnosing AMI were higher than those of serum hs CRP levels.Conclusion Serum extracellular vesicle LP-PLA2 is significantly overexpressed in patients with coronary heart disease after myocardial infarction,and is positively correlated with the degree of vascular disease,indicating that serum extracellular vesicle LP-PLA2 has a predictive value on the occurrence of myocardial infarction in patients with coronary heart disease.