Lp-PLA2的检测在冠状动脉狭窄患者中的临床意义
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摘要
目的探讨血浆脂蛋白相关性磷脂酶A2(LP-PLA2)水平与冠状动脉不同分支狭窄的关系,进一步分析LP-PLA2水平的检测在冠心病患者中的临床意义。方法本次研究共包括268例患者,根据经皮冠状动脉造影术(CAG)结果分组为,对照组(无狭窄),粥样硬化组(主要冠脉分支狭窄≤50%,≥20%),单支病变组(单支狭窄>50%),双支病变组(双支狭窄>50%)和三支病变组(三支或以上狭窄>50%)。采用横断面分析LP-PLA2以及高密度脂蛋白C(HDL-C)、低密度脂蛋白(LDL-C)、总胆固醇(CHOL)、甘油三酯(TG)、载脂蛋白B(ApoB)、载脂蛋白A1(ApoA1)、葡萄糖(GLU)、尿酸(BUA)等生化指标和患者基本情况与冠状动脉狭窄的关系。结果经单因素分析,与对照组比较冠心病传统因素高血压、GLU、HDL-C、ApoA1、BUA或从粥样硬化组,或从单支病变组、双支病变组、三支病变组开始与冠状动脉狭窄相关(P <0.05),而LP-PLA2从单支病变组开始与冠状动脉狭窄显著相关(P <0. 01);通过比较各组间LP-PLA2水平发现,随着冠状动脉病变支数增加Lp-PLA2显著增加(P<0.01),而双支病变组与三支病变组比较其值变化不明显(P>0.05);进一步多元回归分析发现,从单支病变开始LP-PLA2与冠状动脉狭窄独立相关,OR值1.013,95%CI(1.006,1.020),<0.01。结论从冠状动脉单支变化开始LP-PLA2显著增加,并且与冠状动脉狭窄独立相关,因此检测LP-PLA2对冠状动脉狭窄患者病情的评估有重要的临床意义。
Objective To investigate the relationship between plasma lipoprotein-associated phospholipase A2(Lp-PLA2) and coronary artery stenosis. Further to analyze the clinical significance of the detection of Lp-PLA2 levels in patients with coronary heart disease. Methods A total of 268 patients were included in this study and grouped according to CAG results, including the control group(no stenosis), the atherosclerosis group(main coronary artery branch stenosis ≤50%,≥20%),the single lesion group(single branch stenosis>50%),the double-branch disease group(double stenosis >50%) and the three-vessel lesion group(three stenosis >50%). Cross-sectional analysis was conducted to evaluate the relationship between the biochemical indicators and the basic status of patients with coronary artery stenosis, including Lp-PLA2 concentrations and high-density lipoprotein C( HDL-C), low-density lipoprotein( LDL-C), total cholesterol(CHOL),triglyceride(TG), and apolipoprotein B( ApoB). Results Univariate analysis showed that hypertension,GLU,HDL,ApoA1 and BUA were associated with coronary artery stenosis.(P <0.05),while Lp-PLA2 was significantly associated with coronary artery stenosis from a single disease(P <0. 01). By comparing the levels of Lp-PLA2 among groups, it was found that the Lp-PLA2 value increased significantly with the increase of the number of coronary artery lesions(P < 0. 01). Compared between the double-vessel disease group and the three-vessel disease group, the Lp-PLA2 value did not change significantly( P > 0.05).Furthermore, multiple regression analysis showed that Lp-PLA2 was independently associated with coronary artery stenosis from a single-vessel disease with OR value 1.013, and 95% confidence interval(1.006,1.020),(P <0.01). Conclusion The Lp-PLA2 value increases significantly from one coronary artery branch and is independently associated with coronary artery stenosis. Therefore, the detection of Lp-PLA2 value has important clinical significance for the evaluation of coronary artery stenosis.
Objective To investigate the relationship between plasma lipoprotein-associated phospholipase A2(Lp-PLA2) and coronary artery stenosis. Further to analyze the clinical significance of the detection of Lp-PLA2 levels in patients with coronary heart disease. Methods A total of 268 patients were included in this study and grouped according to CAG results, including the control group(no stenosis), the atherosclerosis group(main coronary artery branch stenosis ≤50%,≥20%),the single lesion group(single branch stenosis>50%),the double-branch disease group(double stenosis >50%) and the three-vessel lesion group(three stenosis >50%). Cross-sectional analysis was conducted to evaluate the relationship between the biochemical indicators and the basic status of patients with coronary artery stenosis, including Lp-PLA2 concentrations and high-density lipoprotein C( HDL-C), low-density lipoprotein( LDL-C), total cholesterol(CHOL),triglyceride(TG), and apolipoprotein B( ApoB). Results Univariate analysis showed that hypertension,GLU,HDL,ApoA1 and BUA were associated with coronary artery stenosis.(P <0.05),while Lp-PLA2 was significantly associated with coronary artery stenosis from a single disease(P <0. 01). By comparing the levels of Lp-PLA2 among groups, it was found that the Lp-PLA2 value increased significantly with the increase of the number of coronary artery lesions(P < 0. 01). Compared between the double-vessel disease group and the three-vessel disease group, the Lp-PLA2 value did not change significantly( P > 0.05).Furthermore, multiple regression analysis showed that Lp-PLA2 was independently associated with coronary artery stenosis from a single-vessel disease with OR value 1.013, and 95% confidence interval(1.006,1.020),(P <0.01). Conclusion The Lp-PLA2 value increases significantly from one coronary artery branch and is independently associated with coronary artery stenosis. Therefore, the detection of Lp-PLA2 value has important clinical significance for the evaluation of coronary artery stenosis.
引文
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[10]张冬芹,曾玉杰,董道然,等.冠心病患者血浆脂蛋白相关磷脂酶A2与冠状动脉病变的相关性研究[J].中国医药,2014,9(9):1256-1257.
[11] THOMPSON A, GAO P. Lipoprotein-associated phospholipase A(2)and risk of coronary disease, stroke, and mortality:collaborative analysis of 32 prospective srudies[J]. Lancet, 2010,375(15):1536-1544.
[12]刘甲兴,郑兴,秦永文,等.脂蛋白相关性磷脂酶A2活性能反映冠状动脉粥样硬化病变程度[J].第二军医大学学报,2016,27(4):391-395.
[13] DAIDA H,IWASE T,YAGI S,et al. Effect of darapladib on plasma lipoprotein-associated phospholipase A2 activity in Japanesedylipidemic patients, with exploratory analysis of a PLA2G7 gene polymorphism of VaI279 Phe[J]. Circ J,2013,77(6):1518-1525.
[14]杨琴.血浆脂蛋白相关磷脂酶A2检测在冠状动脉粥样硬化中的应用价值.西部医学,2013,25(5):784-785.
[15] KARA H,AKINCIN M,DEGIRMENCI S,et al. High-sensitivity Creactive protein, lipoprotein-related phospholipase A2 and acute ischemic stroke[J]. Neuropsychiatr Dis Treat, 2014, 6(10):1451-1457.
[16] JAHOR Q, CHOI H, RUEL I, et al. Lipoprotein-associated phospholipase A(2)(Lp-PLA(2))in acute coronary syndrome:relationship with low-density lipoprotein cholesterol[J]. Can J Cardiol,2013,29(12):1679-1686.
[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]龚倩,胡月明,王金金.小而密低密度脂蛋白及常见血脂指标与冠心病的相关性研究[J].标记免疫分析与临床,2017,24(8):845-849.
[4]肖平喜,谭明娟,万芳,等.血清缺血修饰白蛋白在冠心病患者中的临床应用价值[J].标记免疫分析与临床,2017,24(4):374-377.
[5]陈伟伟,高润霖,刘力生,等.中国心血管病报告2013概要[J].中国循环杂志,2014,29(7):487-491.
[6] KOLODGIE F D,BURKE A P,SKORIJIA K S,et al. Lipoproteinassociated phospholipase A2 protein expression in the natural progression of human coronary atherosclerosis[J]. Arteroscler Thromb Vase Biol,2006,26(11):2523-2529.
[7] BLANKENBERG S,STENGEL D,RUPPRECHT H J,et al. Plasma PAF-acetylhydrolase in patients with coronary artery disease:results of CROSS-SECTIONAL ANALYSIS. J Lipid Res, 2003,44(7):1381-1386.
[8] PACKARD C J,O'REILY D S,CASIAKE M J,et al. Lipoproteinassociated phospholipase A_2 as an independent predictor of coronary heart disease. West of Scotland Coronary Prevention Study Group[J]. N Engl J Med,2000,343(16):1148-1155.
[9] LAVI S, MCCONNELL J P, RIHAL C S, et al. Local production of lipoprotein-associated phospholipase A2 and lysophosphatidylcholine in the coronary circulation:association with early coronary atherosclerosis and endothelial dysfunction in humans[J].Circulation, 2007,115(21):2715-2721.
[10]张冬芹,曾玉杰,董道然,等.冠心病患者血浆脂蛋白相关磷脂酶A2与冠状动脉病变的相关性研究[J].中国医药,2014,9(9):1256-1257.
[11] THOMPSON A, GAO P. Lipoprotein-associated phospholipase A(2)and risk of coronary disease, stroke, and mortality:collaborative analysis of 32 prospective srudies[J]. Lancet, 2010,375(15):1536-1544.
[12]刘甲兴,郑兴,秦永文,等.脂蛋白相关性磷脂酶A2活性能反映冠状动脉粥样硬化病变程度[J].第二军医大学学报,2016,27(4):391-395.
[13] DAIDA H,IWASE T,YAGI S,et al. Effect of darapladib on plasma lipoprotein-associated phospholipase A2 activity in Japanesedylipidemic patients, with exploratory analysis of a PLA2G7 gene polymorphism of VaI279 Phe[J]. Circ J,2013,77(6):1518-1525.
[14]杨琴.血浆脂蛋白相关磷脂酶A2检测在冠状动脉粥样硬化中的应用价值.西部医学,2013,25(5):784-785.
[15] KARA H,AKINCIN M,DEGIRMENCI S,et al. High-sensitivity Creactive protein, lipoprotein-related phospholipase A2 and acute ischemic stroke[J]. Neuropsychiatr Dis Treat, 2014, 6(10):1451-1457.
[16] JAHOR Q, CHOI H, RUEL I, et al. Lipoprotein-associated phospholipase A(2)(Lp-PLA(2))in acute coronary syndrome:relationship with low-density lipoprotein cholesterol[J]. Can J Cardiol,2013,29(12):1679-1686.