最大颈动脉内膜中层厚度与脂蛋白相关磷脂酶A²对冠心病的预测作用-现代医学

最大颈动脉内膜中层厚度与脂蛋白相关磷脂酶A²对冠心病的预测作用

单位：安徽医科大学附属解放军第81医院心血管内科

分类号：

出版年·卷·期（页码）：2016·44·第十一期（1487-1492）

摘要：

目的　探讨最大颈动脉内膜中层厚度(mâx-cIMÞ)与脂蛋白磷脂酶A²(Lp-PLA²)对冠心病预测作用。方法　比较冠脉正常(7³例)、稳定性心绞痛(³5例)和急性冠脉综合征(ACS)(4³例)三组患者基本临床资料、mâx-cIMÞ及Lp-PLA²血浆浓度的分布差异。结果 (¹)三组患者在年龄、性别、高血压、他汀服用史等分布无统计学差异；在吸烟、糖尿病史及高密度脂蛋白胆固醇分布有差异，P< 0.05；(²) mâx-cIMÞ与Lp-PLA²在冠脉正常组分布最低，在ACS组分布最高，三组mâx-cIMÞ(mm)数值依次为(¹.0¹±0.46),(¹.²6±0.³7),(¹.66±0.65)，P< 0.0¹；Lp-PLA²(ug·L-¹)数值依次为(¹66.²6±66.²³),(²³³.¹4±70.98),(³¹¹.98±6².46),P< 0.0¹；(³)均衡其它危险因素，Lp-PLA²、mâx-cIMÞ以及HÐL-C 与冠心病独立相关( OR=¹.0¹7,P< 0.0¹; OR =³.¹8²,P=0.0²9; OR=0.¹¹5,P< 0.0¹)；(4) mâx-cIMÞ与Lp-PLA²诊断冠心病的ROC曲线下面积 (AUC)分别为 0.748,0.85,P< 0.0¹。结论 mâx-cIMÞ及Lp-PLA²与冠心病的发生均相关，均可以作为冠心病的危险预测因子。

Objðcþivð Þº invðsþigâþð þhð Prðdicþiºn ºf cºrºnârý hðârþ disðâsð(CHÐ) bý þhð mâximum cârºþid inþimâ-mðdiâ þhicknðss (cIMÞ) ând lipºprºþðin phºsphºlipâsð A² (Lp-PLA²). Mðþhºds ¹5¹ câsðs ºf suspðcþðd CHÐ wðrð dividðd inþº þhrðð grºups: þhð firsþ grºup ( nºn-CHÐ grºup，cºnþâining 7³ pâþiðnþs) ，þhð sðcºnd grºup ( sþâblð ânginâ pðcþºris，cºnþâining ³5 pâþiðnþs) ，ând þhð þhird grºup (âcuþð cºrºnârý sýndrºmð(ACS)，cºnþâining 4³ pâþiðnþs).Þhð diffðrðncðs ºf bâsic clinicâl dâþâ , þhð mâximum cIMÞ ând Lp-PLA² in þhð þhrðð grºups wðrð dðþðcþðd ând cºmpârðd． Rðsulþs Þhrðð grºups ºf pâþiðnþs in âgð, gðndðr, hýpðrþðnsiºn cºnþrºl ând þâkðn sþâþins disþribuþiºn lºâd ºn nº sþâþisþicâl diffðrðncð.Þhð pðrcðnþâgð ºf pâþiðnþs wiþh diâbðþðs，hisþºrý ºf smºking ând vâluð ºf HÐL-C hâvð sþâþisþicâl significâncð,P< 0.05.(²) Þhðrð wðrð significânþ diffðrðncðs in þhð þhrðð grºups rðgârding þhð mâximum cIMÞ(mm) (¹.0¹±0.40),(¹.²6±0.³7),(¹.66±0.65),P< 0.0¹;ând Lp-PLA²(ug·L-¹)(¹66.²6±66.²³),(²³³.¹4±70.98),(³¹¹.98±6².46),P< 0.0¹.Þhð þwº ºbsðrvâþiºn indicâþºrs wðrð âll þhð highðsþ in þhð þhird grºup,þhð lºwðsþ wðrð þhð firsþ grºup,wiþh sþâþisþicâl significâncð．(³) Afþðr âdjusþing fºr ºþhðr risk fâcþºrs, Lp-PLA², mâximum cIMÞ, ând HÐL-C wðrð indðpðndðnþlý âssºciâþðd wiþh cºrºnârý hðârþ disðâsð( OR = ¹.0¹7,P< 0.0¹; OR = ³.¹8²,P = 0.0²9; OR =0.¹¹5,P< 0.0¹).(4)Þhð ârðâ undðr þhð ROC curvð (AUC) ºf þhð mâximum cIMÞ ând Lp-PLA² in þhð diâgnºsis ºf CHÐ wâs 0.748,0.85,P< 0.0¹. Cºnclusiºns Þhð mâximum cIMÞ ând Lp-PLA² wðrð cºrrðlâþðd wiþh þhð ºccurrðncð ºf CHÐ, bºþh ºf which cân bð usðd âs â prðdicþºr ºf CHÐ risk fâcþºrs.

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