脂蛋白相关磷脂酶A2与糖尿病病人颈动脉不稳定斑块的相关性  

ASSOCIATION BETWEEN LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 AND UNSTABLE CAROTID PLAQUES IN PATIENTS WITH DIABETES MELLITUS

作　　者：李珊珊[1] 南文慧 贾玫[1] LI Shanshan, NAN Wenhui, JIA Mei(Department of Clinical Laboratory, Peking University People’s Hospital, Beijing 100044, Chin)

机构地区：[1]北京大学人民医院检验科,北京100044

出　　处：《精准医学杂志》2018年第3期219-222,共4页Journal of Precision Medicine

基　　金：国家高技术研究发展计划(‘863’计划)资助项目(2011AA02A111)

摘　　要：目的探讨脂蛋白相关磷脂酶A2(Lp-PLA2)与糖尿病病人颈动脉不稳定斑块的相关性。方法 2型糖尿病病人203例,分为颈动脉稳定斑块组104例(A组)与颈动脉不稳定斑块组99例(B组),对两组病人血清中的血糖(GLU)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、胆固醇(CHO)、糖化血红蛋白(Hb A1c)、Lp-PLA2进行检测,同时对病人临床基本资料(年龄、BMI、腰臀比、病史年限)进行调查;采用非参数检验、二分类Logistic回归及ROC曲线统计分析生化指标及Lp-PLA2与斑块稳定性的相关性。结果与A组比较,B组Lp-PLA2的活性水平显著升高,差异具有显著意义(Z=-2.584,P<0.05);当校准年龄、糖尿病病史、腰臀比、BMI、CHO、HDL、Hb A1c、GLU、LDL后,与Lp-PLA2最低四分位数(<237 U/L)相比,Lp-PLA2最高四分位数(>402 U/L)的不稳定斑块组OR值为4.56(95%CI=1.30~15.98,P<0.05);评估斑块是否稳定的Lp-PLA2 cutoff值为399.5 U/L,其诊断灵敏度为40.8%,特异度为89.4%。结论 Lp-PLA2的活性水平在不稳定斑块病人中显著升高,是不稳定斑块病人的独立危险因素;当Lp-PLA2的活性为399.5 U/L时,可以辅助诊断斑块是否稳定,且特异性较高。Objective To investigate the association between lipoprotein-associated phospholipase A2（ Lp-PLA2） and unstable carotid plaques in diabetic patients. Methods A total of 203 patients with type 2 diabetes were divided into stable caro-tid plaque group（ group A,n = 104） and unstable carotid plaque group（ group B,n = 99）. The serum levels of glucose（ GLU）,high-density lipoprotein（ HDL）,low-density lipoprotein（ LDL）,cholesterol（ CHO）,hemoglobin A1 c（ Hb A1 c）,and Lp-PLA2 were determined,and the patients＇ age,body mass index（ BMI）,waist-hip ratio,and history of diabetes were investigated; the obtained biochemical parameters and clinical data were analyzed using the nonparametric test. Binary logistic regression analysis and receiver operating characteristic curve analysis were used to analyze the association of Lp-PLA2 and biochemical parameters with plaque stability. Results Compared with group A,group B had significantly increased activity of Lp-PLA2（ Z =-2.584,P〈0.05）. After adjustment for age,the history of diabetes,waist-hip ratio,BMI,CHO,HDL,Hb A1 c,GLU,and LDL,The odds ratio of the highest quartile of Lp-PLA2（ 402 U/L） versus the lowest quartile of Lp-PLA2（ 237 U/L） for unstable carotid plaques was 4.56（ 95%CI = 1.30-15.98,P〈0.05）. The cut-off value of Lp-PLA2 for assessing the stability of carotid plaques was 399.5 U/L,with a sensitivity of 40.8% and a specificity of 89.4%. Conclusion The activity of Lp-PLA2 increases significantly in patients with unstable carotid plaques,which is an independent risk factor for unstable carotid plaques;Lp-PLA2 activity（ cut-off value： 399.5 U/L） will help assess the stability of carotid plaques and has high specificity.

关 键 词：脂蛋白类 磷脂酶A2 糖尿病 动脉粥样硬化 颈动脉 

分 类 号：R543.4[医药卫生—心血管疾病] R587.1[医药卫生—内科学]