不稳定型心绞痛患者血清RBP-4、Lp-PLA2水平及依折麦布治疗影响研究

Levels of serum retinol-binding protein-4 and lipoprotein associated phospholipase A2 and influence of ezetimibe treatment in patients with unstable angina

目的探究不稳定型心绞痛(UA)患者血清视黄醇结合蛋白-4(RBP-4)、脂蛋白相关磷脂酶A2(Lp-PLA2)水平及依折麦布治疗影响。方法选取2021年1月至2023年1月于唐山市人民医院心内科确诊的UA患者84例为研究对象,其中男性48例,女性36例;根据冠状动脉病变程度分为:Gensini评分<20分为轻度组(27例)、20分≤Gensini评分<40分为中度组(36例)和Gensini评分≥40分为重度组(21例);按随机数字表法分为观察组和对照组,每组各42例。所有患者均行常规治疗,对照组在此基础上给予瑞舒伐他汀治疗,观察组给予瑞舒伐他汀+依折麦布治疗,两组患者均连续治疗6个月。比较不同冠状动脉病变程度组RBP-4、Lp-PLA2水平;比较治疗后观察组和对照组脂代谢、RBP-4、Lp-PLA2水平以及不良心血管事件的发生情况。结果①血清RBP-4、Lp-PLA2水平为:轻度组<中度组<重度组,差异有统计学意义(P<0.05)。斯皮尔曼等级相关分析显示,血清RBP-4、Lp-PLA2水平与UA患者冠状动脉病变程度呈正相关(r=0.844、r=0.729,P<0.05)。②重复测量方差分析显示,血脂水平时点、组间、交互比较差异有统计学意义(P<0.05)。治疗前,两组总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)水平的比较,差异无统计学意义(P>0.05);治疗3个月、6个月,两组TC、TG、LDL-C的水平均降低(P<0.05),而HDL-C升高(P<0.05),且观察组TC、TG、LDL-C水平低于对照组,HDL-C水平高于对照组,差异有统计学意义(P<0.05)。③重复测量方差分析显示,RBP-4、Lp-PLA2水平时点、组间、交互比较,差异有统计学意义(P<0.05)。治疗前,两组RBP-4、Lp-PLA2水平比较,差异无统计学意义(P>0.05);治疗3个月、6个月,两组RBP-4、Lp-PLA2水平均降低(P<0.05),且观察组RBP-4、Lp-PLA2水平低于对照组,差异有统计学意义(P<0.05)。④观察组心血管事件发生率(7.14%)低于对照组(23.81%),差异有统计学意义(P<0.05)。结论UA患者血清RBP-4、Lp-PLA2水平与冠状动脉病变程度相关,依折麦布可改善不稳定型心绞痛患者的脂代谢水平,调节血清RBP-4、Lp-PLA2水平,减少心血管事件发生。

Objective To investigate the levels of serum retinol-binding protein-4(RBP-4)and lipoprotein associated phospholipase A2(Lp-PLA2)and influence of ezetimibe treatment in patients with unstable angina(UA).Methods UA patients(n=84,male=48 and female=36)were chosen from Department of Cardiology in People’s Hospital of Tangshan City from Jan.2021 to Jan.2023.According to severity of coronary artery lesions,the patients were divided into mild group(Gensini scores<20,n=27),moderate group(20≤Gensini scores<40,n=36)and severe group(Gensini scores≥40,n=21).The patients were also divided into observation group and control group(each n=42)according to random digital table.All patients were given routine treatment,and control group was additionally treated with rosuvastatin and observation group was treated with rosuvastatin+ezetimibe from 6 months continuously.The levels of serum RBP-4 and Lp-PLA2 were compared among groups of different severity of coronary artery lesions,and lipid metabolism,levels of RBP-4 and Lp-PLA2 and occurrence of adverse cardiovascular events were compared between observation group and control group after treatment.Results①The levels of serum RBP-4 and Lp-PLA2 showed that an ascending trend as follows:mild group<moderate group<severe group(P<0.05).The results of Spearman’s rank correlation analysis showed that RBP-4 and Lp-PLA2 levels were positively correlated to severity of coronary artery lesions in UA patients(r=0.844,r=0.729,both P<0.05).②The results of repeated measurement ANOVA showed that the differences in time points and inter-group and interactive comparisons of blood lipid levels had statistical significance(P<0.05).Before treatment,the differences in levels of total cholesterol(TC),high-density lipoprotein-cholesterol(HDL-C),low-density lipoprotein-cholesterol(LDL-C)and triglyceride(TG)had no statistical significance between observation group and control group(P>0.05).After treatment for 3 and 6 months,levels of TC,TG and LDL-C decreased(P<0.05)and HDL-C level increased(P<0.05)in 2 groups,and levels of TC,TG and LDL-C were lower and HDL-C level was higher in observation group than those in control group(P<0.05).③The results of repeated measurement ANOVA showed that the differences in time points and inter-group and interactive comparisons of RBP-4 and Lp-PLA2 levels had statistical significance(P<0.05).Before treatment,the differences in RBP-4 and Lp-PLA2 levels had no statistical significance between observation group and control group(P>0.05).After treatment for 3 and 6 months,decreased in 2 groups(P<0.05),and RBP-4 and Lp-PLA2 levels were lower in observation group than those in control group(P<0.05).④The incidence rates of adverse cardiovascular events was lower in observation group(7.14%)than those in control group(23.81%,P<0.05).Conclusion The levels of serum RBP-4 and Lp-PLA2 are correlated to severity of coronary artery lesions.Ezetimibe can improve lipid metabolism level,regulate RBP-4 and Lp-PLA2 levels and reduce adverse cardiovascular events in UA patients.