脂蛋白相关磷脂酶A2及血小板活化因子与急性冠脉综合征临床研究

目的探讨急性冠脉综合征患者血浆脂蛋白相关磷脂酶A2（1ipoprotein-associated phospholipaseA，Lp-PIA2）和血小板活化因子（platelet activating factor，PAF）浓度变化及其临床意义。方法选择经冠状动脉造影检查的260例心内科住院患者，按照临床表现及造影结果分组：急性冠脉综合征组115例，包括不稳定型心绞痛亚组70例、急性心肌梗死亚组45例；非急性冠脉综合征冠状动脉粥样硬化性心脏病（冠心病）组94例，包括稳定型心绞痛亚组56例、冠状动脉慢性完全闭塞亚组38例；正常冠状动脉对照组51例。采用夹心酶联免疫吸附法检血浆Lp-PLA2及PAF浓度。结果与对照组比较，急性冠脉综合征及非急性冠脉综合征患者血浆Lp-PLA2（89．05±25．01）μg／Lvs．（11．85±4．17）μg／L，P〈0．001；（19．86±9．91）μg／Lvs．（11．85±4．17）μg／L，P〈O．01l及PAF（139．44±56．49）μg／Lvs．（58．67±12．46）μg／L，P〈O．001；（64．36±13．89）μg／Lvs（58．67±12．46）μg／L，P〈0．05]浓度显著升高，差异均有统计学意义。与对照组比较，亚组中，除稳定型心绞痛亚组血浆Lp—PLA：及PAF浓度无明显升高外（P〉0．05），其余亚组包括不稳定型心绞痛、急性心肌梗死、冠状动脉慢性完全闭塞亚组的Lp—PLA：及PAF浓度均显著升高，差异有统计学意义（均P〈O．01）。结论血浆Lp-PLA2及PAF浓度在急性冠脉综合征患者明显增高，可能提示粥样斑块不稳定性，有可能成为急性冠脉综合征的新的干预靶点。

Clinical significance of level changes in lipoprotein-associated phospholipase A2 and platelet activating factor in acute coronary syndrome

Objectives To examine level changes in plasma lipoprotein-associated phospholipase A2(Lp-PLA2) and platelet activating factor(PAF),and to evaluate their clinical value in acute coronary syndrome(ACS).Methods A total of 260 hospitalized patients undergoing coronary angiography were selected and divided into following groups according to coronary angiography results and clinical characteristics: ACS group(115 cases),non-ACS group(94 cases) and control group with normal coronary arteries(NCA,51 cases).ACS group included unstable angina pectoris subgroup(UAP,70 cases) and acute myocardial infarction subgroup(AMI,45 cases);non-ACS group included stable angina pectoris subgroup(SAP,56 cases) and chronic total occlusion subgroup(CTO,38 cases).Plasma levels of Lp-PLA2 and PAF in all individuals were determined by enzyme linked immunosorbent assay(ELISA).Results Compared with control group,plasma levels of Lp-PLA2 in ACS group (89.05±25.01) μg/L vs.(11.85±4.17) μg/L,P<0.001] and non-ACS group (19.86±9.91) μg/L vs.(11.85±4.17) μg/L,P<0.01] as well as plasma levels of PAF in ACS group (139.44±56.49) μg/L vs.(58.67±12.46) μg/L,P<0.001] and non-ACS group(64.36±13.89) μg/L vs.(58.67±12.46) μg/L,P<0.05] were significantly increased.Except SAP subgroup(P>0.05),Lp-PLA2 and PAF plasma levels in all subgroups including AMI,UAP,and CTO subgroups were elevated obviously(P<0.01) when comparing with those in control group.Conclusions Plasma levels of Lp-PLA2 and PAF increase significantly in ACS patients,which can be a diagnostic predictor and novel treated target for unstable atherosclerotic plaque.