冠状动脉粥样硬化性心脏病患者血清LP-PLA2、NEFA水平变化及其临床意义

Changes of serum LP-PLA2 and NEFA levels in patients with coronary heart disease and their clinical significance

摘要:

目的 探讨冠状动脉粥样硬化性心脏病（以下简称冠心病）患者血清脂蛋白相关磷脂酶A2（LP-PLA2）、游离脂肪酸（NEFA）水平变化并分析其临床意义。方法 选取2015年3月—2016年4月遂宁市中心医院心血管中心收治的冠心病患者138例作为研究组，根据Gensini总积分分为轻度病变组42例，中度病变组47例和重度病变组49例；根据病变支数分为单支病变组40例，双支病变组49例和三支病变组49组。选取同期该院的健康体检者46例作为对照组。比较各组血清LP-PLA2、NEFA水平，并分析血清LP-PLA2、NEFA水平与冠心病患者冠状动脉病变程度的关系及对随访3年发生心血管事件的影响。结果 不同病变组患者的性别、年龄、LP-PLA2、NEFA、伴随糖尿病及高血压比较，差异有统计学意义（P?<0.05），体重指数、吸烟、喝酒、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、同型半胱氨酸（Hcy)、C反应蛋白（CRP）和左室射血分数（LVEF）比较，差异无统计学意义（P?>0.05）。随访至2019年4月，46例健康体检者未出现心血管事件，138例冠心病患者发生心血管事件57例，心血管事件发生率为41.30%。二元Logistic回归分析，结果显示，不同病变程度[OlR=2.546（95% CI：2.001，4.013）]、不同病变支数[OlR=2.453（95% CI：2.000，4.014）]、血清LP-PLA2 [OlR=2.453（95% CI：2.758，5.346）] 和NEFA [OlR=4.034（95% CI：2.014，5.896）]为冠心病患者3年随访期间发生心血管事件的危险因素（P?<0.05)。结论 冠心病患者血清LP-PLA2、NEFA高表达，其水平与冠状动脉病变严重程度密切相关，并影响患者预后。

Abstract:

Objective To study the changes of serum lipoprotein-related phospholipase A2 (LP-PLA2) and nonestesterified fatty acid (NEFA) levels in patients with coronary heart disease and to analyze their clinical significance. Methods From March 2015 to April 2016, 138 patients with coronary heart disease were selected as study group. According to Gensini total score, they were divided into mild lesion group (42 cases), moderate lesion group (47 cases) and severe lesion group (49 cases). According to the number of lesions, 40 patients were divided into the single-vessel disease group (40 cases), double-vessel disease group (49 cases) and three-vessel disease group (49 cases). 46 healthy persons who received physical examination in the same period were selected as control group. The serum level of LP-PLA2 and NEFA was compared in each group, and the relationship between the level of LP-PLA2 and NEFA and the severity of coronary artery disease, and the impact of cardiovascular events on follow-up for 3 years were analyzed. Results There were significant differences in gender ratio, age, LP-PLA2, NEFA, concomitant diabetes and hypertension between the different disease groups (P??0.05). The follow-up ended in April 2019. There were no cardiovascular events in 46 healthy subjects, 57 cases of cardiovascular events occurred in 138 patients with coronary heart disease, and the incidence of cardiovascular events was 41.30%. Binary logistic regression analysis showed that different lesions [OlR?=?2.546 (95% CI: 2.001, 4.013)], different lesions [OlR?=?2.453 (95% CI: 2.000, 4.014) ], serum LP-PLA2 [OlR?=?2.453 (95% CI: 2.758, 5.346) ] and NEFA [OlR?= 4.034 (95% CI: 2.014, 5.896) ] were independent risks for cardiovascular events in patients with coronary heart disease during 3 years of follow-up (P?