脂蛋白相关磷脂酶A2、同型半胱氨酸和高密度脂蛋白胆固醇及D-二聚体检测对冠状动脉易损斑块的预测价值  

Predictive value of lipoprotein associated phospholipase A2,homocysteine,high-density lipoprotein cholesterol and D-dimer on coronary artery vulnerable plaque

作　　者：刘亚东[1] 王海晶 王丽萍 冯莉莉[1] 孙娟[1] 刘欢[1] 王健 杨延星 LIU Ya-dong;WANG Hai-jing;WANG Li-ping;FENG Li-li;SUN Juan;LIU Huan;WANG Jian;YANGYan-xing(Yan′an University Hospital,Yan′an,Shaanxi 716000,China)

机构地区：[1]延安大学附属医院

出　　处：《岭南心血管病杂志》2020年第1期11-15,23,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨血清脂蛋白相关磷脂酶A2(lipoprotein associated phospholipase A2,Lp-PLA2)、同型半胱氨酸(homocysteine,HCY)和高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)及血浆D-二聚体(D-dimer,D-D)检测对冠状动脉易损斑块的诊断价值。方法收集2018年2月至2019年1月在延安大学附属医院心血管内科就诊的冠状动脉粥样硬化性心脏病(冠心病)患者147例。其中为稳定斑块(stable plaques,SP)组87例,易损斑块(vulnerable plaques,VP)组60例。选取同期本院血管内超声和冠状动脉造影检查均为阴性的表观健康体检者200名为健康对照组(healthy controls,HC)组。测定所有纳入者血清Lp-PLA2、HCY、HDL-C浓度及血浆D-D浓度,评价这些指标单独及联合检测对易损斑块的诊断性能。采用单因素方差分析比较各指标组间差异,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)评价各指标对易损斑块的诊断性能。结果VP组血清Lp-PLA2、HCY及HDL-C浓度及血浆D-D浓度均高于SP组(t=25.387、3.636、0.036、44.735,P<0.05)和HC组(t=21.788、2.890、0.032、41.560,P<0.05),差异有统计学意义。ROC分析结果显示,单独检测时,Lp-PLA2[曲线下面积(area under curve,AUC)=0.920]的诊断性能最高,其次为HDL-C(AUC=0.903)、D-D(AUC=0.757)及HCY(AUC=0.698);两两联合检测时,Lp-PLA2+HDL-C(AUC=0.985,Se=96.7%,Sp=93.1%)的诊断性能最高,在此基础上增加D-D(AUC=0.994,z=0.846,P=0.398)或HCY+D-D(AUC=0.997,z=1.864,P=0.062)均未能显著提高对易损斑块的诊断性能。结论单独检测时,Lp-PLA2对易损斑块的诊断性能优于HCY、HDL-C及D-D,Lp-PLA2+HDL-C联合检测对易损斑块有更好的诊断价值。Objectives To explore the predictive value of serum concentrations of lipoprotein associated phospholipase A2(Lp-PLA2),homocysteine(Hcy),high-density lipoprotein cholesterol(HDL-C)and plasma concentration of Ddimer(D-D)on coronary artery vulnerable plaque.Methods Totally 147 patients with coronary heart disease admitted to Yan'an University Hospital from February 2018 to January 2019 were collected.Eighty-seven patients were in stable plaque(SP)group and 60 patients were in vulnerable plaques(VP)group.A total of 200 apparent healthy examination subjects with negative results in both intravascular ultrasound and coronary angiography in our hospital during the same period were selected as healthy control(HC)group.Serum concentrations of Lp-PLA2,HCY,HDL-C and plasma concentration of D-D were measured in all subjects to evaluate the diagnostic performance of these indexes for single or joint testing for vulnerable plaques.One-way analysis of variance(anova)was used to compare the differences of indexes among the three groups.Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic performance of each index for vulnerable plaques.Results Serum concentrations of Lp-PLA2,HCY,HDL-C and plasma concen⁃tration of D-D in VP group were significantly higher than those in SP group(t=25.387,3.636,0.036,44.735;P<0.05)and HC group(t=21.788,2.890,0.032,41.560;P<0.05).ROC results indicated that Lp-PLA2[area under curve(AUC)=0.920]had the highest diagnostic performance when tested alone,followed by HDL-C(AUC=0.903),D-D(AUC=0.757)and HCY(AUC=0.698).Combined detection of Lp-PLA2+HDL-C(AUC=0.985,Se=96.7%,Sp=93.1%)had the highest diagnostic performance,while adding D-D(AUC=0.994,z=0.846,P=0.398)or HCY+D-D(AUC=0.997,z=1.864,P=0.062)could not significantly improve the diagnostic performance of vulnerable plaques.Conclusions Diagnostic performance of Lp-PLA2 is better than that of HCY,HDL-C and D-D,and the combined detection of Lp-PLA2+HDL-C had the better diagnostic value for vulnerable plaques.

关 键 词：冠状动脉疾病 易损斑块 脂蛋白相关磷脂酶A2 同型半胱氨酸 高密度脂蛋白胆固醇 D-二聚体 

分 类 号：R541.4[医药卫生—心血管疾病]