脂蛋白相关磷脂酶A2水平与不稳定型心绞痛患者罪犯病变组织学特征的关系  

The relationship between lipoprotein-associated phospholipase A2 levels and tissue characteristics of culprit lesions in patients with unstable angina pectoris

作　　者：彭吉新 单守杰[2] 刘志忠[2] 张俊杰[2] 金国珍[2] PENG Ji-xin;SHAN Shou-jie;LIU Zhi-zhong;ZHANG Jun-jie;JIN Guo-zhen(Department of Cardiology,Jiangning District Hospital of Chinese Traditional Medicine,Nanjing 211100,China)

机构地区：[1]江宁中医院心病科,江苏南京211100 [2]南京医科大学附属南京医院心内科

出　　处：《中国介入心脏病学杂志》2020年第7期391-396,共6页Chinese Journal of Interventional Cardiology

基　　金：南京市卫生科技发展专项资金项目(YKK18096)。

摘　　要：目的探讨脂蛋白相关磷脂酶A2(Lp-PLA2)与不稳定型心绞痛(UAP)罪犯病变组织学特征的关系。方法连续选取2014年5月至2016年10月在南京医科大学附属南京医院62例UAP患者,根据入院时UAP危险分层将患者分为高危UAP组(24例)和中低危UAP组(38例),对罪犯病变行冠状动脉造影和彩色编码血管内超声(iMAP-IVUS)检查。采用免疫比浊法测定血浆Lp-PLA2水平,分析不同Lp-PLA2水平UAP患者罪犯病变的组织学特征。结果高危UAP组患者Lp-PLA2水平[(598.2±102.3)ng/ml比(303.9±91.6)ng/ml,P=0.003]高于中低危UAP组患者。Lp-PLA2为485.3 ng/ml时,其判别高危UAP的敏感度为87.5%,特异度为89.5%。高Lp-PLA2组(Lp-PLA2≥485.3 ng/ml)患者最小管腔处外弹力膜面积、斑块面积和斑块负荷,正性重构,富含脂质斑块及斑块破裂的比例均显著高于低Lp-PLA2组差异均有统计学意义(均P<0.05)。logistic多因素回归分析显示,Lp-PLA2≥485.3 ng/ml(OR 5.73,95%CI 2.21~12.60,P<0.001)和富含脂质斑块(OR 8.51,95%CI 3.64~15.80,P<0.001)是高危UAP的独立预测因子。结论Lp-PLA2水平与UAP斑块不稳定有关,Lp-PLA2≥485.3 ng/ml和富含脂质斑块是高危UAP的独立预测因子。Objective To explore the relationship between lipoprotein-associated phospholipase A2(Lp-PLA2) levels and tissue characteristics of culprit lesions in patients with unstable angina pectoris(UAP). Methods 62 consecutive patients with UAP who underwent diagnostic coronary angiography from May 2014 to October 2016 in Nanjing Hospital Affiliated to Nanjing Medical University were divided into high risk group(n = 24) and low-medium risk group(n =38) according to risk stratification of UAP at admission. Culprit lesions were imaged by diagnostic coronary angiography and 40 MHz iMAP-IVUS. Immunoturbidimetric assay technique was used to assay the circulating Lp-PLA2. Plaque characteristics of culprit lesion were analyzed for UA patients with various Lp-PLA2 levels. Results Lp-PLA2 level was significantly higher in high risk UAP group than that in low-medium risk UAP group[(598.2±102.3)ng/ml vs.(303.9±91.6)ng/ml,P=0.003]. Optimal threshold of Lp-PLA2 to predict high risk UAP was determined as 485.3 ng/ml with a sensitivity of 87.5% and a specificity of 89.5%,respectively. Patents with higher Lp-PLA2 level(Lp-PLA2≥485.3 ng/ml) was associated with larger external elastic membrane cross-sectional area,plaque area and more plaque burden compared with patients with lower Lp-PLA2 levels(all P<0.05). After logistic regression,positive remodeling,lipid-rich plaque and plaque rupture were significantly more often in patients with higher Lp-PLA2 level than in patients with lower Lp-PLA2 level(all P<0.05).and Lp-PLA≥485.3 ng/ml(OR 5.73,95%CI 2.21–12.60,P<0.001)and lipid-rich plaque(OR 8.51,95%CI 3.64–15.80,P<0.001)were independent risk factors for high risk UAP. Conclusions Lp-PLA2 level was associated with instability of culprit lesion in UAP patients. LpPLA2≥485.3 ng/ml and lipid-rich plaque were independently predictive factors for high risk UAP.

关 键 词：不稳定型心绞痛 脂蛋白相关磷脂酶A2 斑块 彩色编码血管内超声 

分 类 号：R541.4[医药卫生—心血管疾病]