摘要
目的 分析血清脂蛋白相关磷脂酶A2(Lp-PLA2)水平与冠状动脉(冠脉)斑块易损性的关系.方法 选取2022年8月至2023年8月于新疆医科大学第一附属医院收治的冠状动脉粥样硬化性心脏病(冠心病)患者100例,经冠脉血管内超声检查后分为稳定性斑块(SP组)57例,易损斑块(VP组)43例.两组均行光学相干断层成像(OCT)以及血清Lp-PLA2水平检测.分析血清Lp-PLA2水平与OCT检查结果,对于纤维帽厚度、血栓形成、斑块破裂的关系以及血清Lp-PLA2对冠脉斑块易损性的诊断价值.结果 两组性别、年龄、吸烟史、饮酒史比较(P＞0.05),具有可比性.与SP组相比,VP组舒张压、收缩压、糖尿病、高血压、Gensini评分较高(P＜0.05).与SP组相比,VP组纤维帽厚度水平较低,血栓形成、斑块破裂占比较高(P＜0.05).与SP组相比,VP组血清Lp-PLA2水平较高(P＜0.05).血清Lp-PLA2与纤维帽厚度呈负相关,与血栓形成、斑块破裂呈正相关(P＜0.05).以冠脉易损性斑块形成情况作为因变量(未形成=0;形成=1),进行多因素Logistics回归分析结果 显示,舒张压、收缩压、糖尿病、高血压、Gensini评分、Lp-PLA2均为影响冠脉易损性斑块形成的主要因素(P＜0.05).血清Lp-PLA2诊断冠脉斑块易损性的曲线下面积为0.874,敏感度为81.40%,特异性为82.46%,最佳截断值为217.96 ng/ml.结论 冠脉斑块易损冠心病患者血清Lp-PLA2水平较高,血清Lp-PLA2水平与纤维帽厚度、血栓形成、斑块破裂相关,Lp-PLA2水平升高为冠脉斑块易损的危险因素,对冠脉斑块易损性的诊断价值较高.
Abstract
Objective To analyze the relationship between level of serum lipoprotein associated phospholipase A2(Lp-PLA2)and coronary plaque vulnerability.Methods The patients with coronary heart disease(CHD,n=100)were chosen from the First Affiliated Hospital of Xinjiang Medical University from Aug.2022 to Aug.2023.After examination of intravascular ultrasound(IVUS),the patients were divided into stable plaque group(SP group,n=57)and vulnerable plaque group(VP group,n=43).The both groups were given examination of optical coherence tomography(OCT)and detection of serum Lp-PLA2 level.The relationship among Lp-PLA2 level,OCT results,fiber cap thickness,thrombosis and plaque rupture,and diagnostic value of serum Lp-PLA2 to coronary plaque vulnerability were analyzed.Results Gender,age,smoking and drinking history were comparable between 2 groups(P>0.05).The indexes of diastolic blood pressure(DBP),systolic blood pressure(SBP),diabetes,hypertension and Gensini scores were higher in VP group than those in SP group(P<0.05).The level of fiber cap thickness was lower,and percentages of thrombosis and plaque rupture were higher in VP group than those in SP group(P<0.05).The level of serum Lp-PLA2 was higher in VP group than that in SP group(P<0.05).The level of serum Lp-PLA2 was negatively correlated to fiber cap thickness,and positively correlated to thrombosis and plaque rupture(P<0.05).Taken coronary vulnerable plaque formation as dependent variable(non-formation=0,formation=1),the results of multi-factor Logistics regression analysis showed that DBP,SBP,diabetes,hypertension,Gensini scores and Lp-PLA2 all were main factors affecting vulnerable plaques formation(P<0.05).The area under curve of serum Lp-PLA2 was 0.874,specificity was 81.40%,specificity was 82.46%and the optimal cutoff value was 217.96 ng/ml in diagnosing coronary plaque vulnerability.Conclusion The level of serum Lp-PLA2 is higher in CHD patients with coronary vulnerable plaques,and correlated to fiber cap thickness,thrombosis and plaque rupture.The increased level of serum Lp-PLA2 is a risk factor for coronary vulnerable plaques,which has higher diagnostic value to coronary plaque vulnerability.
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