脂蛋白相关磷脂酶A2对冠脉病变严重程度的预测价值  

Predictive value of lipoprotein-associated phospholipase A2 in the severity of coronary lesions

作　　者：龚晓璇[1] 叶泽康 王彤[1,2] 马嘉政 滕建桢 李振 GONG Xiaoxuan;YE Zekang;WANG Tong;MA Jiazheng;TENG Jianzhen;LI Zhen(Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Department of Cardiology,Yancheng First People’s Hosptial,Yancheng 224001;Department of Breast,the Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,江苏南京210029 [2]盐城市第一人民医院心血管内科,江苏盐城224001 [3]南京中医药大学附属医院乳腺病科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2021年第10期1463-1467,1496,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：南京医科大学科技发展基金(2017NJMU088)。

摘　　要：目的:量化评估脂蛋白相关磷脂酶A2(lipoprotein associated phospholipase A2,Lp-PLA2)水平预测冠脉病变严重程度的效果。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SYNTAXⅡ评分的预测价值。结果:Lp-PLA2与冠心病诊断、多支病变、SYNTAXⅡ评分等有相关性(P均<0.05)。Lp-PLA2诊断ACS和多支病变的灵敏度较高(分别为90.9%、80.0%),诊断SYNTAXⅡ评分≥23分及≥33分的特异度较高(分别为81.7%、87.4%)。Lp-PLA2是多支病变、SYNTAXⅡ评分≥23分及≥33分的独立危险因素(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=2.800,P<0.05)、高血压与糖尿病患者SYNTAXⅡ评分≥23分的风险较高(高血压亚组OR=3.586;糖尿病亚组OR=18.000,P均<0.05)。结论:Lp-PLA2可以有效预测冠脉病变严重程度,尤其是诊断ACS和多支病变的灵敏度和SYNTAXⅡ评分≥23分及≥33分的特异度较高,对高血压及糖尿病患者的冠脉病变预测价值更大。Objective:To quantitative assess the effect of lipoprotein associated phospholipase A2(Lp-PLA2)level in predicting the severity of coronary lesions. 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 SYNTAX Ⅱ score. Results:Lp-PLA2 was correlated with the diagnosis of coronary artery disease,multi-vessel lesions and SYNTAX Ⅱ score(all P< 0.05). LpPLA2 had high sensitivity in predicting ACS(90.9%)and multi-vessel lesions(80.0%),high specificity in predicting SYNTAX Ⅱscore ≥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 SYNTAX Ⅱscore ≥23 and ≥33. The predictive value of Lp-PLA2 for coronary lesions is greater in hypertension and diabetes patients.

关 键 词：脂蛋白相关磷脂酶A2 急性冠脉综合征 多支病变 SYNTAXⅡ评分 

分 类 号：R543.3[医药卫生—心血管疾病]