脂蛋白相关磷脂酶A2与老年冠心病患者PCI术后心肌损伤的相关性研究
|
摘要
目的探讨老年冠心病患者脂蛋白相关磷脂酶A2(Lp-PLA2)与经皮冠状动脉介入术(PCI)围术期心肌损伤(PMI)的关系及其预测价值。方法纳入2016年1月至2018年6月我院行PCI的老年冠心病患者100例,收集基线资料,检测PCI术前术后心肌肌钙蛋白T(cTnT)、高敏C反应蛋白(hs-CRP)、Lp-PLA2及其他生物化学指标。根据术后cTnT是否升高,将患者分为对照组(cTnT未升高)55例和观察组(cTnT升高)45例。比较2组的临床资料和PCI术中情况。Logistic回归分析PMI的危险因素。结果 2组高血压病史、糖尿病史、吸烟史、既往PCI史、他汀类药物服用史、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、肌酐、N端B型利钠肽原差异均无统计学意义(P>0.05),观察组载脂蛋白B水平高于对照组(P<0.05)。观察组Lp-PLA2及hs-CRP水平较对照组明显升高(P<0.05)。观察组Gensini积分、支架数量、支架释放压、手术用时明显大于对照组(P<0.05)。Logistic回归分析显示,Lp-PLA2(OR 4.55,95%CI 1.43～14.47)、Gensini积分(OR 1.08,95%CI 1.01～1.14)、支架数量(OR 5.35,95%CI 2.04～14.01)以及手术用时(OR 1.06,95%CI 1.00～1.12)为PMI相关危险因素。结论术前Lp-PLA2升高是老年冠心病患者PCI相关心肌损伤的危险因素,对PMI有预测价值。
Aim To investigate the relationship between lipoprotein-associated phospholipase A2(Lp-PLA2)and perioperative myocardial injury(PMI) in elderly patients with coronary heart disease and its predictive value.Methods From January 2016 to June 2018,100 elderly patients with coronary heart disease who underwent PCI in our hospital were included in the study. Baseline data of patients were collected,and cardiac troponin T(cT nT),high-sensitivity C-reactive protein(hs-CRP),Lp-PLA2 and other biochemical parameters were measured before and after PCI operation. According to whether cT nT was elevated or not after PCI operation,the patients were divided into control group(55 cases without elevation of cTnT) and observation group(45 cases with elevation of cT nT). Clinical data and intraoperative status of PCI were compared between the two groups. Logistic regression was used to analyze the risk factors of PMI.Results There were no significant differences in hypertension,diabetes,smoking,PCI,statins use,high density lipoprotein cholesterol,low density lipoprotein cholesterol,creatinine and N-terminal pro-B-type natriuretic peptide between the two groups(P>0.05). The level of apolipoprotein B in observation group was higher than that in control group(P<0.05). The levels of Lp-PLA2 and hs-CRP in the observation group were significantly higher than those in the control group(P<0.05). Gensini integral,stent number,stent release pressure and operation time in observation group were significantly higher than those in control group(P<0.05). Logistic regression analysis showed that Lp-PLA2(OR 4. 55,95%CI 1. 43-14. 47),Gensini score(OR 1. 08,95%CI 1. 01-1. 14),stent number(OR 5. 35,95%CI 2. 04-14. 01) and operation time(OR 1. 06,95%CI 1. 00-1. 12) were risk factors for PMI. Conclusion Preoperative elevation of LpPLA2 is a risk factor for PCI-related myocardial injury in elderly patients with coronary heart disease and has predictive value for PMI.
Aim To investigate the relationship between lipoprotein-associated phospholipase A2(Lp-PLA2)and perioperative myocardial injury(PMI) in elderly patients with coronary heart disease and its predictive value.Methods From January 2016 to June 2018,100 elderly patients with coronary heart disease who underwent PCI in our hospital were included in the study. Baseline data of patients were collected,and cardiac troponin T(cT nT),high-sensitivity C-reactive protein(hs-CRP),Lp-PLA2 and other biochemical parameters were measured before and after PCI operation. According to whether cT nT was elevated or not after PCI operation,the patients were divided into control group(55 cases without elevation of cTnT) and observation group(45 cases with elevation of cT nT). Clinical data and intraoperative status of PCI were compared between the two groups. Logistic regression was used to analyze the risk factors of PMI.Results There were no significant differences in hypertension,diabetes,smoking,PCI,statins use,high density lipoprotein cholesterol,low density lipoprotein cholesterol,creatinine and N-terminal pro-B-type natriuretic peptide between the two groups(P>0.05). The level of apolipoprotein B in observation group was higher than that in control group(P<0.05). The levels of Lp-PLA2 and hs-CRP in the observation group were significantly higher than those in the control group(P<0.05). Gensini integral,stent number,stent release pressure and operation time in observation group were significantly higher than those in control group(P<0.05). Logistic regression analysis showed that Lp-PLA2(OR 4. 55,95%CI 1. 43-14. 47),Gensini score(OR 1. 08,95%CI 1. 01-1. 14),stent number(OR 5. 35,95%CI 2. 04-14. 01) and operation time(OR 1. 06,95%CI 1. 00-1. 12) were risk factors for PMI. Conclusion Preoperative elevation of LpPLA2 is a risk factor for PCI-related myocardial injury in elderly patients with coronary heart disease and has predictive value for PMI.
引文
[1] Thygesen K,Alpert JS,Jaffe AS,et al.Fourth universal definition of myocardial infarction (2018)[J].Kardiol Pol,2018,76(10):1383-1415.
[2] 陈伟伟,高润霖,刘力生,等.中国心血管病报告2017概要[J].中国循环杂志,2018,33(1):1-8.
[3] 王红梅,胡耀华,章若涵,等.尿微量白蛋白在冠状动脉介入治疗术后对心肌损伤的评估作用[J].中国动脉硬化杂志,2010,18(12):982-984.
[4] 陈韦任,朱平,刘宏伟.年龄>75岁老年患者冠状动脉介入治疗随访研究[J].中国动脉硬化杂志,2012,20(8):739-741.
[5] 陈燕春,殷云杰,徐亮,等.脂蛋白相关磷脂酶A2预测稳定型心绞痛患者经皮冠状动脉介入治疗围手术期心肌损伤研究[J].介入放射学杂志,2017,26(12):1073-1077.
[6] Zeng RX,Li JJ,Liao PD,et al.Relationship of non-cardiac biomarkers with periprocedural myocardial injury in patients undergoing percutaneous coronary intervention[J].Int J Cardiol,2016,221:726-733.
[7] Herrmann J.Peri-procedural myocardial injury:2005 update[J].Eur Heart J,2005,26(23):2493-2519.
[8] 贾张蓉,赵冬,齐玥,等.脂蛋白相关磷脂酶A2活性水平的性别差异及其与心血管病危险因素的关系[J].中华心血管病杂志,2013,41(11):962-967.
[9] Talmud PJ,Holmes MV.Deciphering the causal role of sPLA2s and Lp-PLA2 in coronary heart disease[J].Arterioscler Thromb Vasc Biol,2015,35(11):2281-2289.
[10] Rosenson RS,Stafforini DM.Modulation of oxidative stress,inflammation,and atherosclerosis by lipoprotein-associated phospholipase A2[J].J Lipid Res,2012,53(9):1767-1782.
[11] Younus A,Humayun C,Ahmad R,et al.Lipoprotein-associated phospholipase A2 and its relationship with markers of subclinical cardiovascular disease:A systematic review[J].J Clin Lipidol,2017,11(2):328-337.
[12] 中国老年学学会心脑血管病专业委员会,中国医师协会检验医师分会心脑血管病专家委员会.脂蛋白相关磷脂酶A2临床应用专家建议[J].中华心血管病杂志,2015,43(10):843-847.
[2] 陈伟伟,高润霖,刘力生,等.中国心血管病报告2017概要[J].中国循环杂志,2018,33(1):1-8.
[3] 王红梅,胡耀华,章若涵,等.尿微量白蛋白在冠状动脉介入治疗术后对心肌损伤的评估作用[J].中国动脉硬化杂志,2010,18(12):982-984.
[4] 陈韦任,朱平,刘宏伟.年龄>75岁老年患者冠状动脉介入治疗随访研究[J].中国动脉硬化杂志,2012,20(8):739-741.
[5] 陈燕春,殷云杰,徐亮,等.脂蛋白相关磷脂酶A2预测稳定型心绞痛患者经皮冠状动脉介入治疗围手术期心肌损伤研究[J].介入放射学杂志,2017,26(12):1073-1077.
[6] Zeng RX,Li JJ,Liao PD,et al.Relationship of non-cardiac biomarkers with periprocedural myocardial injury in patients undergoing percutaneous coronary intervention[J].Int J Cardiol,2016,221:726-733.
[7] Herrmann J.Peri-procedural myocardial injury:2005 update[J].Eur Heart J,2005,26(23):2493-2519.
[8] 贾张蓉,赵冬,齐玥,等.脂蛋白相关磷脂酶A2活性水平的性别差异及其与心血管病危险因素的关系[J].中华心血管病杂志,2013,41(11):962-967.
[9] Talmud PJ,Holmes MV.Deciphering the causal role of sPLA2s and Lp-PLA2 in coronary heart disease[J].Arterioscler Thromb Vasc Biol,2015,35(11):2281-2289.
[10] Rosenson RS,Stafforini DM.Modulation of oxidative stress,inflammation,and atherosclerosis by lipoprotein-associated phospholipase A2[J].J Lipid Res,2012,53(9):1767-1782.
[11] Younus A,Humayun C,Ahmad R,et al.Lipoprotein-associated phospholipase A2 and its relationship with markers of subclinical cardiovascular disease:A systematic review[J].J Clin Lipidol,2017,11(2):328-337.
[12] 中国老年学学会心脑血管病专业委员会,中国医师协会检验医师分会心脑血管病专家委员会.脂蛋白相关磷脂酶A2临床应用专家建议[J].中华心血管病杂志,2015,43(10):843-847.