血浆脂联素、脂蛋白相关磷脂酶A2检测联合颈动脉超声检查对冠状动脉易损斑块的诊断价值  

Value of plasma adiponectin and lipoprotein-associated phospholipase A_(2) detection combined with carotid ultrasound in diagnosis of vulnerable coronary plaque

作　　者：张显敏 梁琳 ZHANG Xianmin;LIANG Lin(Department of Ultrasound Medicine,the First People's Hospital of Xianyang,Xianyang 712099,China)

机构地区：[1]咸阳市第一人民医院超声医学科,陕西咸阳712099

出　　处：《陕西医学杂志》2022年第6期713-716,共4页Shaanxi Medical Journal

基　　金：陕西省重点研发计划项目(2018SF-169)。

摘　　要：目的:探讨血浆脂联素(APN)、脂蛋白相关磷脂酶A_(2)(Lp-PLA_(2))检测联合颈动脉超声检查对冠状动脉易损斑块的诊断价值。方法:选取冠心病患者98例,根据冠状动脉粥样硬化斑块的性质分为易损斑块组(62例)和稳定型斑块组(36例)。另选取体检健康者40例为健康对照组。比较三组血浆APN和Lp-PLA_(2)水平。利用颈动脉超声评估冠心病患者的冠状动脉斑块性质,以冠状动脉造影及血管内超声检查为金标准,分析颈动脉超声与金标准的一致性。绘制受试者工作特征(ROC)曲线,分析血浆APN、Lp-PLA_(2)、颈动脉超声单项及联合对冠状动脉易损斑块的诊断价值。结果:易损斑块组血浆APN水平低于稳定型斑块组和健康对照组,血浆Lp-PLA_(2)水平高于稳定型斑块组和健康对照组(均P<0.05)。稳定型斑块组血浆APN水平低于健康对照组,血浆Lp-PLA_(2)水平高于健康对照组(均P<0.05)。颈动脉超声诊断冠状动脉易损斑块的敏感度为83.87%,特异度为80.56%,与金标准的一致性较好(Kappa=0.633)。血浆APN和Lp-PLA_(2)诊断冠状动脉易损斑块的灵敏度为69.35%和82.26%,特异度为77.78%和72.22%。血浆APN和Lp-PLA_(2)联合颈动脉超声诊断冠状动脉易损斑块的灵敏度为90.32%,特异度为88.89%。结论:血浆APN、Lp-PLA_(2)检测联合颈动脉超声检查能够较好地诊断冠状动脉易损斑块。Objective:To investigate the value of plasma adiponectin(APN)and lipoprotein-associated phospholipase A_(2)(Lp-PLA_(2))combined with carotid ultrasound in the diagnosis of vulnerable coronary plaque.Methods:A total of 98 patients with coronary heart disease were selected and divided into vulnerable plaque group(62 cases)and stable plaque group(36 cases)according to the nature of coronary atherosclerotic plaque.Another 40 healthy subjects were selected as healthy control group.Plasma APN and Lp-PLA_(2) levels were compared among the three groups.Carotid ultrasound was used to assess the nature of coronary plaque in patients with coronary heart disease.The concordance between carotid ultrasound and gold standard was analyzed using coronary angiography and intravascular ultrasound as gold standard.Receiver operating characteristic(ROC)curves were drawn to analyze the diagnostic value of plasma APN,Lp-PLA_(2),carotid ultrasound single and combined in the diagnosis of vulnerable coronary plaques.Results:Plasma APN level in vulnerable plaque group was lower than that in stable plaque group and healthy control group,and plasma Lp-PLA_(2) level was higher than that in stable plaque group and healthy control group(all P<0.05).Plasma APN level in stable plaque group was lower than that in healthy control group,and plasma Lp-PLA_(2) level was higher than that in healthy control group(all P<0.05).The sensitivity and specificity of carotid ultrasound in the diagnosis of vulnerable coronary plaque were 83.87%and 80.56%,with good concordance with the gold standard(Kappa=0.633).The sensitivity of plasma APN and Lp-PLA_(2) for diagnosing vulnerable coronary plaque was 69.35%and 82.26%,and the specificity was 77.78%and 72.22%.Plasma APN and Lp-PLA_(2) combined with carotid ultrasound showed a sensitivity of 90.32%and a specificity of 88.89%for the diagnosis of vulnerable coronary plaque.Conclusion:Plasma APN and Lp-PLA_(2) combined with carotid ultrasound can better diagnose vulnerable coronary plaque.

关 键 词：脂联素 脂蛋白相关磷脂酶A_(2) 颈动脉超声 冠状动脉 易损斑块 诊断价值 

分 类 号：R541.4[医药卫生—心血管疾病]