Lp—PLA2与冠心病冠脉病变程度及内皮功能的相关性研究

【目的】探讨冠心病（CHD）患者血清脂蛋白相关磷脂酶A2（Lp-PLA2）水平与冠脉病变程度及内皮功能的相关性。【方法】选择本科室收治的行冠脉造影的连续病例300例，根据诊断结果将其分为cHD组（n=250）和非CHD组（n=50），比较两组血清Lp-PLA2、肱动脉血流介导的内皮舒张功能（FMD）；计算CHD组患者冠脉病变Gensini积分，根据Gensini积分不同分为低Gensini积分组（LS组）、中Gensini积分组（MS组）和高Gensini积分组（HS组），比较不同冠脉病变患者血清Lp-PLA2、FMD、Gensini积分及三者之间的相关性。【结果1CHD组血清Lp-PLA2水平显著高于非CHD组，FMD显著低于非CHD组，差异均具有统计学意义（均P〈0．05）。急性冠脉综合征（ACS）患者血清Lp-PLA2水平、Gensini积分均高于稳定型心绞痛（SAP）患者，FMD低于SAP纽，差异具有统计学意义（P〈0．05）。HS纽血清Lp-PLA2水平高于LS组、MS纽，FMD低于LS组、Ms组，差异均具有统计学意义（均P〈0．05）；MS组血清Lp-PLA2水平高于LS组，FMD低于LS组，差异均具有统计学意义（均P〈0．05）。血清Lp-PLA2水平与FMD呈显著负相关，与Gensini积分呈显著正相关；Gensini积分与FMD呈显著负相关。【结论]Lp-PLA2是CHD患者的危险因素，并与CHD患者冠脉病变程度及FMD相关，而与动脉粥样硬化的发生、发展的关系尚须进一步深入的临床研究。

Relations Among Serum Lp-PLA2,Severity of Stenosis,and Endothelial Function in Patients with Cor-onary Heart Disease

Objective]To explore relations among serum 1ipoprotein‐associated phospholipase A2 (Lp‐PLA2) , severity of stenosis ,and endothelial function in patients with Coronary Heart Disease (CHD) .[Methods]Three hun‐dred consecutive cases of patients who were hospitalized for chest pain were studied and Selective Coronary Angiogra‐phy was applied .Among the patients ,250 cases were diagnosed to be with CHD ,and the others to be without CHD . Serum Lp‐PLA2 level ,blood fat ,fast glucose ,blood pressure ,Gensini score of stenosis ,and Flow Mediated Dilation (FMD) were detected in all cases and compared between the two groups .The patients were divided into three other groups according to Gensini scores :Low Gensini Score group (LS) ,Moderate Gensini Score group (MS) ,and High Gensini Score group (HS) .Relations among Lp‐PLA2 ,Gensini Score ,and FMD were also observed .[Results]Level of LDL‐C and Lp‐PLA2 of patients with CHD were higher than in those without CHD ,while FMD of patients with CHD were lower than of those without CHD .The differences were statistically significant ( P < 0 .05) .Other mark‐ers were indiscriminate between the two groups .Levels of Lp‐PLA2 and Gensini Score were higher in patients with Acute Coronary Syndrome (ACS) than those of patients with Stable Angina Pectoris (SAP) ,while the relationship between levels of FMD of the two kinds of patients was the opposite .The differences were statistically significant ( P< 0 .05) .Levels of Lp‐PLA2 were higher in the HS group than that of the MS group and the LS group ,while FMD levels of the HS group were lower than of the MS and LS groups .Level of Lp‐PLA2 was positively correlated with Gensini Score and negatively correlated with FMD .[Conclusion]Lp‐PLA2 is one of the risk factors of CHD .It's relat‐ed to severity of coronary stenosis and stability of plaque .Its detrimental impact on atherosclerosis may be caused by its impairment of endothelial cells .Lp‐PLA2 is an effective marker for screening for CHD .