血清MPO、MHR、Lp-PLA2水平对冠心病的诊断及病情监测的临床价值  

The clinical value of serum MPO,MHR,Lp-PLA2 level in the diagnosis and monitoring of coronary heart disease

作　　者：杨自力 张洁[2] 党好[2] 刘姗[2] 黄蓉[1] YANG Zili;ZHANG Jie;DANG Hao;LIU Shan;HUANG Rong(School of Medical Technology,Xinxiang Medical University,Xinxiang,Henan 453000,China;Department of Clinical Laboratory,the Third Hospital of Mianyang,Sichuan Mental Health Center,Mianyang,Sichuan 621000,China)

机构地区：[1]新乡医学院医学技术学院,河南新乡453000 [2]绵阳市第三人民医院(四川省精神卫生中心)检验科,四川绵阳621000

出　　处：《热带医学杂志》2025年第2期167-172,I0002,共7页Journal of Tropical Medicine

基　　金：国家自然青年科学基金项目(32400637);河南省高等学校重点科研项目计划(21A310010)。

摘　　要：目的探讨冠心病发生急性心肌梗死(AMI)患者的血清髓过氧化物酶(MPO)、单核细胞与高密度脂蛋白胆固醇比值(MHR)、脂蛋白相关磷脂酶A2(Lp-PLA2)水平在AMI的诊断及病情严重程度的相关性。方法纳入2023年8月-2024年3月绵阳市第三人民医院确诊的冠心病患者222例(心绞痛111例,AMI 111例)及健康对照者111名。分别采用化学发光法、上转发光法检测MPO、Lp-PLA2水平,单核细胞计数与高密度脂蛋白胆固醇计算得出MHR值。多因素logistic回归分析冠心病患者发生AMI的相关因素;受试者工作特征曲线下面积(AUC)分析研究指标的诊断效能;MPO、MHR、Lp-PLA2在AMI组的冠状动脉病变特点的阳性率比较用χ^(2)检验。结果AMI组血清MPO、MHR、Lp-PLA2水平高于心绞痛组和健康对照组,差异均有统计学意义(F=12.416、47.623、24.749,P均<0.05)。多因素logistic回归分析发现,MPO、MHR、Lp-PLA2是冠心病患者发生AMI的相关因素(P均<0.05)。MPO+MHR+Lp-PLA2筛查AMI的AUC为0.955,高于高敏肌钙蛋白I的AUC0.920,差异有统计学意义(Z=2.020,P=0.043)。MPO+MHR+Lp-PLA2在冠脉轻度狭窄、中度狭窄的阳性检出率均高于MPO、MHR、Lp-PLA2单项检测的阳性检出率,差异均有统计学意义(χ^(2)=35.861、12.602、12.602,30.388、6.750、6.750,P均<0.05)。相较于轻度狭窄及单支狭窄,重度狭窄及多支狭窄的AMI患者的MPO+MHR+Lp-PLA2阳性检出率更高,差异均有统计学意义(χ^(2)=10.452、7.111,P均<0.05)。结论AMI患者MPO、MHR、Lp-PLA2水平显著增高,MPO、MHR、Lp-PLA2是冠心病发生AMI的相关因素。三者联检在AMI的诊断及病情监测(提示轻、中度冠状动脉狭窄及冠脉病变严重程度)方面有着重要临床价值。Objective To investigate the levels of serum myeloperoxidase(MPO),ratio of monocytes to high-density lipoprotein cholesterol ratio(MHR)and lipoprotein-associated phospholipase A2(Lp-PLA2)in patients with coronary heart disease,especially patients with acute myocardial infarction(AMI),and to explore the correlation of research indexes in the diagnosis and severity of AMI.Methods Participants were hospitalized from August 2023 to March 2024 at the Third Hospital of Mianyang were enrolled.Included 111 patients with angina pectoris,111 patients with AMI,and 111 healthy individuals.Chemiluminescence method and up-conversion luminescence method were used to measure MPO and Lp-PLA2respectively;MHR was obtained from the ratio of monocyte count to high density lipoprotein cholesterol.Multivariate logistic regression analysis was used to analyze the related factors of AMI in patients with coronary heart disease.The diagnostic efficacies of MPO,MHR and Lp-PLA2 for AMI were compared using the area under the curve(AUC)of the receiver operating characteristic.The χ^(2) test was used for comparison of the rates of MPO,MHR and Lp-PLA2 positivity in diagnosing AMI with different coronary vein characteristics.Results The levels of serum MPO,MHR and Lp-PLA2 in the AMI group were significantly higher than those in the angina pectoris group and the healthy control group(F=12.416,47.623,24.749;all P<0.05).Multivariate logistic regression showed that serum MPO,MHR and Lp-PLA2 levels were correlated with AMI(all P<0.05).The AUC of MPO+MHR+Lp-PLA2 joint screening for AMI was 0.955,which was higher than that of high sensitivity cardiac troponin(0.920)(Z=2.020,P=0.043).The positive rate of MPO+MHR+Lp-PLA2 in mild and moderate coronary stenosis was higher than that of MPO,MHR and Lp-PLA2(χ^(2)=35.861,12.602,12.602;30.388,6.750,6.750;all P<0.05).Compared with mild coronary artery stenosis and single coronary artery stenosis,the positive rate of MPO+MHR+Lp-PLA2 were higher in AMI patients with severe coronary artery stenosis and multiple co

关 键 词：冠心病 急性心肌梗死 脂蛋白相关磷脂酶A2 单核细胞与高密度脂蛋白胆固醇比值 髓过氧化物酶 

分 类 号：R541.4[医药卫生—心血管疾病]