血清Lp-PLA2和ANGPTL8水平对冠心病及冠状动脉病变程度的诊断价值研究  

Diagnostic value of serum Lp-PLA2 and ANGPTL8 levels on the degree of coronary heart disease and coronary artery disease

作　　者：宋思育 何廉旗 胡庆薇 贾晶晶 宋占春 SONG Siyu;HE Lianqi;HU Qingwei;JIA Jingjing;SONG Zhanchun(Postgraduate Training Base of Fushun Central Hospital,Jinzhou Medical University,Fushun,Liaoning 113006,China;Department of Cardiology,Fushun Central Hospital,Fushun,Liaoning 113006,China)

机构地区：[1]锦州医科大学抚顺市中心医院研究生培养基地,辽宁抚顺113006 [2]辽宁省抚顺市中心医院心内科,113006

出　　处：《重庆医学》2023年第16期2459-2464,共6页Chongqing medicine

基　　金：辽宁省抚顺市“抚顺英才计划”青年拔尖人才项目(FSYC202007002)。

摘　　要：目的研究血清脂蛋白相关磷脂酶A2(Lp-PLA2)、血管生成素样蛋白8(ANGPTL8)水平对冠状动脉粥样硬化性心脏病(CHD)、冠状动脉病变程度的诊断价值。方法选取2021年7月至2022年4月因胸痛就诊于抚顺市中心医院并完善冠状动脉造影检查(CAG)的患者113例作为研究对象。根据CAG结果,将受试者分为CHD组(n=77)和对照组(n=36)。对CHD组行亚组分析,分为一支病变组(n=27),两支病变组(n=18)和三支病变组(n=32),通过Gensini评分评估冠状动脉狭窄程度。检测受试者血清Lp-PLA2和ANGPTL8水平。应用线性回归和logistic回归,分析其与CHD、冠状动脉狭窄程度的相关因素。通过受试者工作特征(ROC)曲线判断血清Lp-PLA2和ANGPTL8水平对CHD的预测价值。结果CHD组患者血清Lp-PLA2和ANGPTL8水平明显高于对照组,且亚组水平由高到低依次为三支病变组、两支病变组、一支病变组,差异均统计学意义(P<0.05)。多因素logistic回归结果显示,血清Lp-PLA2和ANGPTL8水平是CHD的影响因素[比值比(OR)=12.188,95%置信区间(95%CI):2.088~71.158,P=0.005;OR=10.005,95%CI:1.878~53.296,P=0.007]。线性回归结果显示,甘油三酯(TG)、Lp-PLA2和ANGPTL8是冠状动脉病变严重程度的影响因子(β=0.394,P<0.001;CHD患者血清Lp-PLA2和ANGPTL8水平较非CHD者明显增高,两者与冠状动脉病变程度相关,两者联合可以作为CHD诊断的辅助手段(β=0.389,P<0.001;β=0.232,P=0.001)。ROC曲线结果显示,Lp-PLA2联合ANGPTL8可以更好地辅助诊断CHD(AUC=0.904,P<0.001)。结论CHD患者血清Lp-PLA2和ANGPTL8水平较非CHD者明显增高,两者联合可以作为CHD诊断的辅助手段。Objective To investigate the diagnostic value of the levels of serum lipoprotein phospholipase A2(Lp-PLA2)and angiopoietin-like protein 8(ANGPTL8)on the degree of coronary heart disease(CHD)and coronary artery disease.Methods From July 2021 to April 2022,a total of 113 patients who were admitted to Fushun Central Hospital due to chest pain and improved coronary angiography(CAG)were selected as the research objects.According to the CAG results,the subjects were divided into the CHD group(n=77)and the control group(n=36).The CHD group was divided into the one lesion group(n=27),the two lesions group(n=18)and the three lesions group(n=32)by subgroup analysis,and the degree of coronary artery stenosis was evaluated by Gensini score.Serum levels of Lp-PLA2 and ANGPTL8 were determined among all the subjects.Linear regression and logistic regression were used to analyze the related factors with CHD and coronary artery stenosis.The predictive value of serum Lp-PLA2 and ANGPTL8 levels for CHD was judged by the receiver’s operating characteristic(ROC)curve.Results The levels of serum Lp-PLA2 and ANGPTL8 in the CHD group were higher than those in the control group(P<0.001),and the subgroups were the three lesion group,the two lesion group and the one lesion group from high to low,with statistical significance(P<0.05).The results of multivariate logistic regression showed that Lp-PLA2 and ANGPTL8 levels were influencing factors for CHD(OR=12.188,95%CI:2.088-71.158,P=0.005;OR=10.005,95%CI:1.878-53.296,P=0.007).The results of linear regression showed that ANGPTL8,Lp-PLA2 and triglyceride(TG)were influencing factors of the severity of coronary atherosclerosis(β=0.394,P<0.001;β=0.389,P<0.001;β=0.232,P=0.001).The ROC curve found that Lp-PLA2 combined with ANGPTL8 could better predict CHD(AUC=0.904,P<0.001).Conclusion The levels of serum Lp-PLA2 and ANGPTL8 in patients with CHD are significantly higher than those without CHD.The combination of them can be used as an auxiliary means for the diagnosis of CHD.

关 键 词：冠心病 冠状动脉病变支数 冠状动脉狭窄程度 脂蛋白相关磷脂酶A2 血管生成素样蛋白8 GENSINI评分 

分 类 号：R543[医药卫生—心血管疾病]