冠心病患者sPLA2与hs—CRP联合测定及其临床意义

目的探讨血清分泌型磷脂酶A2（sPLA2）联合高敏C反应蛋白（hs—CRP）测定对冠状动脉粥样硬化性心脏病（简称冠心痛）患者远期心血管事件的临床预测意义。方法经冠状动脉造影证实的172例冠心病患者，分别在入院时测定其sPLA2、hs—CRP，并按不同测定水平分组，通过2年随访，观察sPLA2、hs—CRP对远期心血管事件的预测意义。结果2年后共发生心血管事件49例．高sPLA2组（≥66．48u／m1）的心血管事件发生率为38-46％，调整了高血压、糖尿病、吸烟、冠脉3支病变等传统危险因素后。Cox风险回归提示高sPLA2是预测远期事件的独立危险因素之一，相对危险度（RR）2．76；2年后高hs—CRP组（≥0．03g／L）的心血管事件发生率为39．24％，其RR为2．55；而两者同时升高的患者（sPLA2≥66．48u／ml合并hs～CRP≥0．03g／L）远期心血管事件发生率为52．08％，RR为3.34；在低LDL—C冠心病患者中，高sPLA2、高hs—CRP及高sPLA2＋高hs—CRP组患者2年后发生心血管事件的RR分别为2．66、2．77、3．73。结论sPLA2是冠心病发生远期心血管事件的独立危险因素之一，联合hs—CRP测定能提高对冠心病，特别是LDL—C患者心血管事件的临床预测意义。

Value of determination of secretory phospholipase A2 and high-sensitivity C-reactive protein in patients with coronary heart disease

Objective To explore the prognostic value of determination of secretory phospholipase A2 （sPLA2） and high-sensitivity C-reactive protein （hs-CRP） in patients with coronary heart disease （CHD）. Methods The levels of sPLA2 and hs-CRP were measured in 172 patients with CHD diagnosed by coronary angiography. After 2 years follow-up, corresponding cardiovascular events were recorded in every group. Results There were totally 49 events after 2 years. The cumulative cardiovascular events rate in high sPLA2 patients （≥66.48u/ml） was 38.46% with odds ratio of 2.76 after adjustment of traditional risk factors. The cumulative cardiovascular events rate in high hs-CRP patients （≥0.03g/L） after 2 years was 39.24% with odds ratio of 2.55. The patients with both high levels of the two above had a higher future events rate of 52.08% with odds ratio of 3.34. In addition, patients with low LDL-C were selected and found the similar results （the odds ratio was 2.66 of sPLA2, 2.77 of hs-CRP, 3.73 of the two）. Conclusions Elevated sPLA2 level might be one of the independent risk factors for cardiovascular events. The measurement of both basic sPLA2 and hs-CRP levels might increase the clinical value for predicting future events in patients with CHD, especially in low LDL-C patients.