脂蛋白相关磷脂酶A2对冠脉病变严重程度的预测价值
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1.南京医科大学第一附属医院心血管内科;2.盐城市第一人民医院心血管内科;3.南京医科大学第一附属医院急诊医学中心

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Predictive value of lipoprotein-associated phospholipase A2 in the severity of coronary lesions
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Department of Emergency, First Affiliated Hospital of Nanjing Medical University

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    摘要:

    目的:脂蛋白相关磷脂酶A2(lipoprotein associated phospholipase A2,Lp-PLA2)是心血管炎症指标之一,但目前缺乏量化评估Lp-PLA2水平预测冠脉病变严重程度的研究。方法:入选行冠状动脉造影及Lp-PLA2检测的患者共123例,评估Lp-PLA2对急性冠脉综合征(acute coronary syndrome,ACS)、多支病变及SYNTAX II评分的预测价值。结果:Lp-PLA2与冠心病诊断、多支病变、SYNTAX II评分等有相关性(P均<0.05)。Lp-PLA2诊断ACS和多支病变的敏感性较高(分别为90.9%、80%),诊断SYNTAX II评分≥23及≥33的特异性较高(分别为81.7%、87.4%)。Lp-PLA2是多支病变、SYNTAX II评分≥23及≥33的独立危险因素(OR分别为1.004、1.003及1.004,P均<0.05)。亚组分析显示,Lp-PLA2水平升高可预测高血压患者多支病变(OR为2.800,P<0.05)、高血压与糖尿病患者SYNTAX II评分≥23的风险较高(高血压亚组OR为3.586;糖尿病亚组OR为18.000,P均<0.05)。结论:Lp-PLA2可以有效的预测冠脉病变严重程度,尤其是诊断ACS和多支病变的敏感性和SYNTAX II评分≥23及≥33的特异性较高,对高血压及糖尿病患者的冠脉病变预测价值更大。

    Abstract:

    Objective: Lipoprotein associated phospholipase A2 (Lp-PLA2) is one of the markers of cardiovascular inflammation, but the quantitative assessment of Lp-PLA2 levels in predicting the severity of coronary lesions is lacking. Methods: A total of 123 patients who underwent coronary angiography and Lp-PLA2 detection were enrolled to evaluate Lp-PLA2 level in predicting acute coronary syndrome (ACS), multi-vessel lesions and SYNTAXII score. Results: Lp-PLA2 was correlated with the diagnosis of coronary artery disease, multi-vessel lesions and SYNTAX II score (all P<0.05). Lp-PLA2 had high sensitivity in predicting ACS (90.9%) and multi-vessel lesions (80%) and high specificity in predicting SYNTAX II score ≥23 (81.7%) and ≥33 (87.4%). Lp-PLA2 was an independent risk factor for multi-vessel lesions and SYNTAX II score ≥23 and ≥33 (OR=1.004, 1.003 and 1.004, respectively, all P<0.05). Subgroup analysis showed that the higher concentration of Lp-PLA2 predicted the higher risk of multi-vessel lesions in hypertension (OR=2.800, P <0.05) and higher risk of SYNTAX II score ≥23 in hypertension and diabetes patients (OR=3.586 and 18.000, respectively, both P <0.05). Conclusion: Lp-PLA2 can effectively predict the severity of coronary lesions, especially the sensitivity of ACS diagnosis and multi-vessel lesions and the specificity of SYNTAXII score ≥23 and ≥33. The predictive value of Lp-PLA2 for coronary lesions is greater in hypertension and diabetes patients.

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  • 收稿日期:2021-02-18
  • 最后修改日期:2021-06-24
  • 录用日期:2021-10-28
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