脂蛋白相关磷脂酶A2在冠心病患者严重程度评估中的应用

目的评估脂蛋白相关磷脂酶A2（Lp-PLA2）在冠心病患者严重程度评估及远期心血管事件发生预测中的价值。方法将165例因胸痛行冠状动脉造影的患者按造影结果分为冠心病组98例其中稳定性心绞痛（SAP）患者59例、急性冠状动脉综合症（ACS）患者39例]和非冠心病组67例。冠心病组按照病变累及的冠状动脉支数分为单支、二支和三支组,同时对每位冠心病患者进行Gensini评分。检测所有患者入院后24 h内的血浆Lp-PLA2及总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）水平。随访1～2年,记录主要不良心血管事件。分析不同病例组别、不同病变支数和有、无发生主要不良心血管事件患者的Lp-PLA2水平差异。结果冠心病患者Lp-PLA2水平明显高于非冠心病组（P〈0.01）,ACS患者Lp-PLA2水平高于SAP患者（P〈0.05）。冠心病组TC和LDL-C水平与非冠心病组比较均无差异。冠心病三支病变组Lp-PLA2水平明显高于单支和二支病变组（P〈0.01、P〈0.05）,而单支、二支病变组间无差异（P〉0.05）。不良心血管事件阳性患者Lp-PLA2水平明显高于阴性患者（P〈0.01）。结论 Lp-PLA2可用于临床冠心病患者严重程度的评估,且在远期主要不良心血管事件的发生中具有一定的预测价值。

The application of plasma Lp-PLA2 determination in the severity evaluation among the patients with coronary artery disease

Objective To evaluate the predictive value of lipoprotein-associated phospholipase A2（Lp-PLA2） in the severity evaluation and future cardiovascular events among the patients with coronary artery disease（CAD）.Methods 165 chest pain patients were enrolled and administrated coronary artery angiography.The patients were classified into stable angina pectoris（SAP） group（59 patients）,acute coronary syndrome（ACS） group（39 patients） and non-coronary artery disease group（67 patients） according to the angiography results.The coronary artery disease patients were grouped into single-branch group,double-branch group and three-branch group.The Gensini score of each coronary artery disease patient was obtained.The levels of plasma Lp-PLA2,total cholesterol（TC） and low density lipoprotein cholesterol（LDL-C） were detected.The patients were followed up 1 to 2 years and recorded the major adverse cardiovascular events.The differences between different groups with Lp-PLA2 levels were analyzed.Results The level of Lp-PLA2 in coronary artery disease patients was significantly higher than that in non-coronary artery disease patients（P0.01）,and the level of Lp-PLA2 in ACS patients was higher than that in SAP patients（P0.05）.There was no statistical difference in the levels of TC and LDL-C in the coronary artery disease and non-coronary artery disease groups.The patients in three-branch group had higher level of Lp-PLA2 than the patients in single-and double-branch groups（P0.01,P0.05）,and there was no difference between single-branch group and double-branch group（P0.05）.The Lp-PLA2 level in patients being followed up with adverse cardiovascular events was higher than that in the patients without adverse cardiovascular events（P0.01）.Conclusions Lp-PLA2 is a useful item to evaluate the severity,and can be a predictor of future main adverse cardiovascular events.