血清sdLDL-C和Lp-PLA2水平在冠心病亚型鉴别及诊断冠状动脉病变程度的价值

Value of serum levels of sdLDL-C and Lp-PLA2 in differentiating the coronary heart disease subtypes and diagnosing the severity of coronary artery lesions

目的探讨血清小而密LDL-C(sdLDL-C)和脂蛋白相关磷脂酶A2(Lp-PLA2)水平在冠心病(CHD)亚型鉴别及诊断冠状动脉病变程度的价值。方法经冠状动脉造影确诊CHD患者194例;其中,急性冠脉综合征(ACS)105例,稳定型心绞痛(SAP)89例。根据冠状动脉病变程度将患者分为轻度组62例(Gensini评分0~30分)、中度组89例(Gensini评分31~60分)和重度组43例(Gensini评分≥61分)。同时选取冠状动脉造影未诊断为CHD的受检者51例作为对照(C)组。过氧化物酶法检测血清sdLDL-C水平,ELISA法检测血清Lp-PLA2水平,多因素logistic回归分析CHD发生的危险因素;比较CHD亚型及冠状动脉病变不同程度亚组血清sdLDL-C和Lp-PLA2水平,分析血清sdLDL-C和Lp-PLA2水平与Gensini评分的相关性,采用ROC曲线分析其对冠状动脉病变程度的诊断价值。结果血清LDL-C、TG、TC、sdLDL-C和Lp-PLA2水平升高均是CHD发生的独立危险因素(P<0.05或P<0.01)。与C组比较,SAP组、ACS组血清sdLDL-C和Lp-PLA2水平均升高,且ACS组升高更明显(P<0.05)。与C组比较,轻度组、中度组及重度组血清sdLDL-C水平均升高,且随冠状动脉病变程度的加重而升高(P<0.05)。与C组比较,中度组、重度组血清Lp-PLA2水平均升高,且重度组升高更明显(P<0.05)。血清sdLDL-C和Lp-PLA2水平与Gensini评分均呈正相关(r=0.641和0.517,P<0.01),且对中、重度冠状动脉病变有较好的诊断价值。结论血清sdLDL-C和Lp-PLA2水平在不同CHD亚型存在差异,与冠状动脉病变程度呈正相关,可以较好地诊断中、重度冠状动脉病变。

Objective To investigate the value of serum levels of small and dense LDL-C(sdLDL-C)and lipoprotein-associated phospholipase A2(Lp-PLA2)in differentiating the coronary heart disease(CHD)subtypes and diagnosing the severity of coronary artery lesions.Methods A total of 194 patients with CHD confirmed by coronary angiography were subdivided into acute coronary syndrome(ACS)group(105 cases)and stable angina pectoris(SAP)group(89 cases).According to the severity of coronary artery lesions,the patients were divided into three groups of mild(Gensini score 0-30 points,62 cases),moderate(Gensini score 31-60 points,89 cases)and severe(Gensini score≥61 points,43 cases).The subjects who were not diagnosed with CHD by coronary angiography were selected as the control group.Serum sdLDL-C level was detected by peroxidase method,serum Lp-PLA2 level was detected by ELISA.The risk factors for CHD were analyzed by multivariate logistic regression.Serum levels of sdLDL-C and Lp-PLA2 were compared between the two CHD subtypes and among the three coronary artery lesions subgroups.The correlation of serum levels of sdLDL-C and Lp-PLA2 with Gensini score was analyzed,and the diagnostic value of serum levels of sdLDL-C and LP-PLA2 for coronary artery lesions severity was analyzed by ROC curve.Results The elevated levels of serum LDL-C,TG,TC,sdLDL-C and Lp-PLA2 were the independent risk factors for CHD(P<0.05 or P<0.01).Serum levels of sdLDL-C and Lp-PLA2 in groups of SAP and ACS were increased than those in control group,which were more obvious in ACS group(P<0.05).Serum sdLDL-C level was increased in the groups of mild,moderate and severe in a severity dependent manner(P<0.05).Serum Lp-PLA2 level was increased in the groups of moderate and severe than that in control group,which was more obvious in severe group(P<0.05).Serum levels of sdLDL-C and Lp-PLA2 were positively correlated with Gensini score(r=0.641 and 0.517,P<0.01),which had a good diagnostic value for moderate or severe coronary artery lesions.Conclusion Serum levels of sdLDL-C and Lp-PLA2 are different between the CHD subtypes,and are positively correlated with the severity of coronary artery lesions and may better diagnose the severity of moderate or severe coronary artery lesions.