血浆脂蛋白相关磷脂酶A2与急性心肌梗死患者心功能相关性研究

目的：研究急性心肌梗死患者血浆脂蛋白相关磷脂酶A2（Lp-PLA2）浓度变化情况及其与心肌梗死后心功能的相关性。方法：连续入选急性心肌梗死患者90例，测定患者入院即刻（T0）、入院次日（T1）、入院第3天（T2）和入院第7天（T3）血浆LP-PLA2及心梗后1个月(T4)N端前体脑钠肽（NT-proBNP）水平，并采用二维心脏超声测定T1和T4患者左室射血分数（LVEF），Pearson相关分析LP-PLA2与LVEF及NT-proBNP的相关性。以43例同期入院稳定性心绞痛患者和48例健康体检者作为对照。结果：急性心肌梗死患者血浆Lp-PLA2水平呈动态改变，急性心肌梗死后患者血浆Lp-PLA2水平均显著增高，而入院第7天后基本降至对照组水平[（61.42±36.99）mg/L vs. （49.83±27.17）mg/L, P>0.05]。相关性分析显示入院即刻（T0）血浆LP-PLA2水平与C反应蛋白水平（r=0.06，P>0.05）及血浆肌钙蛋白T水平（r=-0.07，p>0.05）均无显著相关性。进一步研究发现入院时（T0）血浆Lp-PLA2水平与T4血浆NT-proBNP水平（r=0.16，p>0.05）、左室射血分数（LVEF）（r=-0.09，p>0.05）及T4与T1 LVEF差值（ΔLVEF）（r=0.04，p>0.05）均无显著相关性。结论：血浆Lp-PLA2水平反映了急性心肌梗死动脉斑块不稳定过程，但与急性心肌梗死患者梗死后心功能恢复情况无关。

The relationship between the concentration of plasma Lp-PLA2 and cardiac function after acute myocardial infarction

Objective: To study the changes of plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) concentration in patients with acute myocardial infarction (AMI) and its correlation with cardiac function after AMI. Methods: 90 consecutive AMI patients who met the study criteria were enrolled. The plasma Lp-PLA2 levels were measured immediately after admission (T0), the next day (T1), the third day (T2) and the seventh day (T3). Left ventricular ejection fraction (LVEF) was measured by two-dimensional echocardiography one month after discharge. Pearson correlation analysis was used to analyze the correlation between Lp-PLA2 and LVEF one month after myocardial infarction. In addition, 48 healthy volunteers and 43 stable angina pectoris patients were enrolled as the controls. Results: The level of plasma Lp-PLA2 showed dynamic changes after myocardial infarction. The level of plasma Lp-PLA2 increased significantly after the onset of the disease, but decreased to normal level after 7th days of admission (61.42±36.99 vs. 49.83±27.17 mg/L, p>0.05). The correlation analysis showed that there was no significant correlation between plasma Lp-PLA2 level and the on-admission level of C-reactive protein (r=0.06, P > 0.05) and cardiac troponin T (r=-0.07, p > 0.05). Further studies showed that there was no significant correlation between plasma Lp-PLA2 level at admission (T0) and the level of plasma NT-proBNP (r=0.16, p>0.05) or left ventricular ejection fraction (LVEF) at 1 month after AMI (r=-0.09, p>0.05). Conclusion: The plasma level of Lp-PLA2 was significantly increased after acute myocardial infarction, but its level was not related to the recovery of cardiac function after acute myocardial infarction.