冠状动脉狭窄患者血浆脂蛋白相关性磷脂酶A_2相关因素分析
|
摘要
目的探讨冠状动脉狭窄患者血浆脂蛋白相关性磷脂酶A_2(Lp-PLA_2)水平升高的影响因素。方法选择2015年10月至2017年5月该院收治的具有心绞痛且怀疑冠状动脉粥样硬化性心脏病(CHD)患者263例,根据冠状动脉造影结果分为对照组(无狭窄或狭窄程度小于20%,35例)、粥样硬化组(主要冠状动脉狭窄程度20%～<50%,21例)、单支病变组(狭窄程度大于或等于50%的单支病变,66例)、双支病变组(狭窄程度大于或等于50%的双支病变,46例)和三支病变组(狭窄程度大于或等于50%的三支或三支以上病变,95例)。分析Lp-PLA_2水平与CHD危险因素血脂、脂蛋白及血糖等的相互关系。结果从冠状动脉狭窄单支病变开始Lp-PLA_2水平显著增加,与Lp-PLA_2呈正相关的因素为患者年龄、载脂蛋白B(ApoB)、血糖(r=0.155、0.179、0.260,P=0.025、0.003、0.001),与Lp-PLA_2呈负相关的因素为高密度脂蛋白胆固醇、ApoA1、游离三碘甲状腺原氨酸(r=-0.264、-0.312、-0.332,P=0.001、0.001、0.007);年龄、ApoB与Lp-PLA_2独立相关(B=2.85、123.67,Beta=0.315、0.275,P=0.026、0.026)。结论从冠状动脉狭窄单支病变开始LpPLA_2水平显著增加,且与患者年龄和ApoB独立相关。
Objective To investigate the influencing factors of elevated plasma lipoprotein-related phospholipase A_2(Lp-PLA_2)levels in patients with coronary artery stenosis.Methods A total of 263 patients with angina and suspected coronary atherosclerotic cardiopathy(CHD),who were enrolled in the hospital from October 2015 to May 2017,were selected and divided into control group(no stenosis or stenosis≤ 20%,n=35),atherosclerosis group C the degree of major coronary stenosis<50%,but≥20%,n=21),single-vessel disease group(single stenosis ≥ 50%,n=66),double-vessel disease group(double stenosis ≥ 50%,n=46)and three-vessel disease group(three or more stenosis≥50%,n=95)according to the results of coronary angiography(CAG).The relationship between the Lp-PLA_2 concentration and risk factors as blood lipids,lipoproteins and blood glucose were analyzed.Results The Lp-PLA_2 concentration increased significantly from the single-vessel disease of coronary artery stenosis.Lp-PLA_2 was positively correlated with age,ApoB and blood glucose(r=0.155,0.179,0.260;P=0.025,0.003,0.001),while negatively correlated with HDL-C ApoA1 and free triodothy ronine(r=-0.264,-0.312,-0.332;P=0.001,0.001,0.007).Lp-PLA_2 was independently related with age and ApoB(B=2.85,123.67;Beta=0.315,0.275;P=0.026,0.026).Conclusion The Lp-PLA_2 concentration is significantly increased from a single change in coronary artery stenosis,and it is independently associated with age and plasma ApoB.
Objective To investigate the influencing factors of elevated plasma lipoprotein-related phospholipase A_2(Lp-PLA_2)levels in patients with coronary artery stenosis.Methods A total of 263 patients with angina and suspected coronary atherosclerotic cardiopathy(CHD),who were enrolled in the hospital from October 2015 to May 2017,were selected and divided into control group(no stenosis or stenosis≤ 20%,n=35),atherosclerosis group C the degree of major coronary stenosis<50%,but≥20%,n=21),single-vessel disease group(single stenosis ≥ 50%,n=66),double-vessel disease group(double stenosis ≥ 50%,n=46)and three-vessel disease group(three or more stenosis≥50%,n=95)according to the results of coronary angiography(CAG).The relationship between the Lp-PLA_2 concentration and risk factors as blood lipids,lipoproteins and blood glucose were analyzed.Results The Lp-PLA_2 concentration increased significantly from the single-vessel disease of coronary artery stenosis.Lp-PLA_2 was positively correlated with age,ApoB and blood glucose(r=0.155,0.179,0.260;P=0.025,0.003,0.001),while negatively correlated with HDL-C ApoA1 and free triodothy ronine(r=-0.264,-0.312,-0.332;P=0.001,0.001,0.007).Lp-PLA_2 was independently related with age and ApoB(B=2.85,123.67;Beta=0.315,0.275;P=0.026,0.026).Conclusion The Lp-PLA_2 concentration is significantly increased from a single change in coronary artery stenosis,and it is independently associated with age and plasma ApoB.
引文
[1] PACKARD C J,O′REILLY D S,CASLAKE M J,et al.Lipoprotein-associated phospholipase A2as an Independent predictor of coronary heart disease.West of Scotland Coronary Prevention Study Group[J].N Engl J Med,2000,343(16):1148-1155.
[2]徐冬玲,刘军妮,杜贻萌,等.脂蛋白相关磷脂酶与冠状动脉易损斑块的相关性[J].中华内科杂志,2009,48(8):651-654.
[3] YANG L,LIU Y,WANG S,et al.Association between Lp-PLA2and coronary heart disease in Chinese patients[J].J Int Med Res,2017,45(1):159-169.
[4] LAVI S,MCCONNELL J P,RIHAL C S,et al.Local production of lipoprotein-associated phospholipase A2and lysophosphatidylcholine in the coronary circulation:association with early coronary atherosclerosis and endothelial dysfunction in humans[J].Circulation,2007,115(21):2715-2721.
[5] CASLAKE M J,PACKARD C J,SUCKLING K E,et al.Lipoprotein-associated phospholipase A(2),platelet-activating factor acetylhydrolase:apotential new risk factor for coronary artery disease[J].Atherosclerosis,2000,150(2):413-419.
[6] GONCALVES I,EDSFELDT A,KO N Y,et al.Evidence supporting a key role of Lp-PLA2-generated lysophosphatidylcholine in human atherosclerotic plaque inflammation[J].Arterioscler Thromb Vasc Biol,2012,32(6):1505-1512.
[7]李丹华,周迎春.血浆脂蛋白相关磷脂酶A2临床价值研究进展[J].国际检验医学杂志,2017,38(16):2255-2258.
[8] RALLIDIS L S,TELLIS C C,LEKAKIS J,et al.Lipoprotein-associated phospholipase A(2)bound on high-density lipoprotein is associated with lower risk for cardiac death in stable coronary artery disease patients:a 3-year followup[J].J Am Coll Cardiol,2012,60(20):2053-2060.
[9] DALAGER M G,B?TTCHER M,THYGESEN J,et al.Different plaque composition and progression in patients with stable and unstable coronary syndromes evaluated by cardiac CT[J].Biomed Res Int,2015,2015:401357.
[10]CAI A,ZHENG D,QIU R,et al.Lipoprotein-associated phospholipase A2(Lp-PLA(2)):a novel and promising biomarker for cardiovascular risks assessment[J].Dis Markers,2013,34(5):323-331.
[11]DAIDA H,IWASE T,YAGI S,et al.Effect of darapladib on plasma lipoprotein-associated phospholipase A2activity in Japanese dyslipidemic patients,with exploratory analysis of a PLA2G7gene polymorphism of Val279Phe[J].Circ J,2013,77(6):1518-1525.
[12]AUSTEN W G,EDWARDS J E,FRYE R L,et al.A reporting system on patiengs evaluated for coronary artery disease.Report of the Ad Hoc Committee for Grading of Coronary Artery Disease,Council on Cardiovascular Surgery,American Heart Association[J].Circulation,1975,51(4Suppl):S5-40.
[13]付琳,钱波,党菲.急性冠脉综合征血浆脂蛋白相关磷脂酶A2表达变化的临床意义[J].西部医学,2016,28(3):409-411.
[14]LIND L,SIMON T,JOHANSSON L,et al.Circulating levels of secretory-and lipoprotein-associated phospholipase A2activities:relation to atherosclerotic plaques and future all-cause mortality[J].Eur Heart J,2012,33(23):2946-2954.
[15]KOLODGIE F D,BURKE A P,SKORIJA K S,et al.Lipoprotein-associated phospholipase A2protein expression in the natural progression of human coronary atherosclerosis[J].Arterioscler Thromb Vasc Biol,2006,26(11):2523-2529.
[16]EPPS K C,WILENSKY R L.Lp-PLA?-a novel risk factor for high-risk coronary and carotid artery disease[J].J Intern Med,2011,269(1):94-106.
[17]MAJEED F,MILLER M.Low high-density lipoprotein cholesterol:an important consideration in coronary heart disease risk assessment[J].Curr Opin Endocrinol Diabetes Obes,2008,15(2):175-181.
[18]GOUDEVENOS J,TSELEPIS A D,VINI M P,et al.Platelet-associated and secreted PAF-acetylhydrolase activity in patients with stable angina:sequential changes of the enzyme activity after angioplasty[J].Eur J Clin Invest,2001,31(1):15-23.
[2]徐冬玲,刘军妮,杜贻萌,等.脂蛋白相关磷脂酶与冠状动脉易损斑块的相关性[J].中华内科杂志,2009,48(8):651-654.
[3] YANG L,LIU Y,WANG S,et al.Association between Lp-PLA2and coronary heart disease in Chinese patients[J].J Int Med Res,2017,45(1):159-169.
[4] LAVI S,MCCONNELL J P,RIHAL C S,et al.Local production of lipoprotein-associated phospholipase A2and lysophosphatidylcholine in the coronary circulation:association with early coronary atherosclerosis and endothelial dysfunction in humans[J].Circulation,2007,115(21):2715-2721.
[5] CASLAKE M J,PACKARD C J,SUCKLING K E,et al.Lipoprotein-associated phospholipase A(2),platelet-activating factor acetylhydrolase:apotential new risk factor for coronary artery disease[J].Atherosclerosis,2000,150(2):413-419.
[6] GONCALVES I,EDSFELDT A,KO N Y,et al.Evidence supporting a key role of Lp-PLA2-generated lysophosphatidylcholine in human atherosclerotic plaque inflammation[J].Arterioscler Thromb Vasc Biol,2012,32(6):1505-1512.
[7]李丹华,周迎春.血浆脂蛋白相关磷脂酶A2临床价值研究进展[J].国际检验医学杂志,2017,38(16):2255-2258.
[8] RALLIDIS L S,TELLIS C C,LEKAKIS J,et al.Lipoprotein-associated phospholipase A(2)bound on high-density lipoprotein is associated with lower risk for cardiac death in stable coronary artery disease patients:a 3-year followup[J].J Am Coll Cardiol,2012,60(20):2053-2060.
[9] DALAGER M G,B?TTCHER M,THYGESEN J,et al.Different plaque composition and progression in patients with stable and unstable coronary syndromes evaluated by cardiac CT[J].Biomed Res Int,2015,2015:401357.
[10]CAI A,ZHENG D,QIU R,et al.Lipoprotein-associated phospholipase A2(Lp-PLA(2)):a novel and promising biomarker for cardiovascular risks assessment[J].Dis Markers,2013,34(5):323-331.
[11]DAIDA H,IWASE T,YAGI S,et al.Effect of darapladib on plasma lipoprotein-associated phospholipase A2activity in Japanese dyslipidemic patients,with exploratory analysis of a PLA2G7gene polymorphism of Val279Phe[J].Circ J,2013,77(6):1518-1525.
[12]AUSTEN W G,EDWARDS J E,FRYE R L,et al.A reporting system on patiengs evaluated for coronary artery disease.Report of the Ad Hoc Committee for Grading of Coronary Artery Disease,Council on Cardiovascular Surgery,American Heart Association[J].Circulation,1975,51(4Suppl):S5-40.
[13]付琳,钱波,党菲.急性冠脉综合征血浆脂蛋白相关磷脂酶A2表达变化的临床意义[J].西部医学,2016,28(3):409-411.
[14]LIND L,SIMON T,JOHANSSON L,et al.Circulating levels of secretory-and lipoprotein-associated phospholipase A2activities:relation to atherosclerotic plaques and future all-cause mortality[J].Eur Heart J,2012,33(23):2946-2954.
[15]KOLODGIE F D,BURKE A P,SKORIJA K S,et al.Lipoprotein-associated phospholipase A2protein expression in the natural progression of human coronary atherosclerosis[J].Arterioscler Thromb Vasc Biol,2006,26(11):2523-2529.
[16]EPPS K C,WILENSKY R L.Lp-PLA?-a novel risk factor for high-risk coronary and carotid artery disease[J].J Intern Med,2011,269(1):94-106.
[17]MAJEED F,MILLER M.Low high-density lipoprotein cholesterol:an important consideration in coronary heart disease risk assessment[J].Curr Opin Endocrinol Diabetes Obes,2008,15(2):175-181.
[18]GOUDEVENOS J,TSELEPIS A D,VINI M P,et al.Platelet-associated and secreted PAF-acetylhydrolase activity in patients with stable angina:sequential changes of the enzyme activity after angioplasty[J].Eur J Clin Invest,2001,31(1):15-23.