Lp-PLA2及常见心血管危险因素与单支临界冠状动脉病变斑块性质的相关性

发布时间：2018-01-17 21:10

本文关键词：Lp-PLA2及常见心血管危险因素与单支临界冠状动脉病变斑块性质的相关性　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究单支临界冠状动脉病变最重处斑块成分构成与传统心血管危险因素及脂蛋白相关磷脂酶A2(Lipoprotein-associated phospholipase A2,Lp-PLA2)之间的关系,同时分析冠脉病变的斑块性质及其影响因素在稳定型心绞痛和急性冠脉综合征患者之间的区别,对临床冠心病患者冠脉病变斑块性质的估计及治疗方向提供参考。方法:采用回顾性研究分析方法,共纳入192例经冠脉造影显示单支冠脉临界狭窄病变患者,分为稳定性心绞痛患者(Stable angina pectoris,SAP)104例和急性冠脉综合征患者(Acute coronary syndrome,ACS)88例,收集常见心血管危险因素及LP-PLA2等基线数据并比较两组差异。使用i MAP-IVUS对临界冠状动脉粥样硬化斑块进行分析,将长轴图像按照1mm间距进行分割形成横截面,寻找病变狭窄最重处并测定最小管腔面积(minimum lumen area,MLA),手动描绘外弹力膜界面和管腔界面,测定病变最重处4种不同性质的斑块构成面积,即纤维斑块面积(Fibrous plaque area,FPA)、纤维脂肪面积(Fibro-fatty area,FFA)、坏死斑块面积(Necrotic core area,NCA)及钙化斑块面积(Dense calcium area,DCA),测定外弹力膜面积(Cross-sectional areas of vascular external elastic membrane,EEMCSA)、斑块面积(Cross-sectional areas of plaque and media,PMCSA)以及计算斑块负荷(plaque burden,PB)等指标并比较两组差异,采用单因素及多元线性回归分析各指标的相关预测因子。使用二分类Logistic回归分析冠心病患者发生急性冠脉综合征的预测因素,使用ROC曲线评估相关连续变量的预测价值并计算各自的临界值及对应的诊断灵敏度及特异度。结果:(1)与SAP组比较,ACS组有更多的糖尿病和吸烟患者,更高的Lp-PLA2血浆浓度和低密度脂蛋白胆固醇(Low-density lipoprotein cholesterol,LDL-C)以及较低的高密度脂蛋白胆固醇(High-density lipoprotein cholesterol,HDL-C),P值均小于0.05。(2)与SAP组比较,ACS组的病变血管有更高的EEMCSA、PMCSA、PB、纤维斑块面积(Fibrous plaque area,FPA)和坏死斑块面积(Necrotic core area,NCA),P值均小于0.01。(3)单因素回归分析中,PB及FPA的危险预测因素包括糖化血红蛋白(Glycated haemoglobin,GHb A1C)、甘油三酯(Triglycerides,TG)、总胆固醇(Total cholesterol,TC)、LDL-C和Lp-PLA2,服用他汀药物史及HDL-C是其共同保护因素。NCA的危险预测因素包括高血压、年龄、GHb A1C、TC、LDL-C和Lp-PLA2,HDL-C是其保护因素。FFA及DCA未见明显相关预测因素。亚组分析SAP与ACS两组各自斑块性质及斑块负荷相关预测因素的结果不尽相同,详见后述。(4)多元回归分析中,在调整其他危险因素后,GHb A1C与Lp-PLA2仍是PB、FPA及NCA的共同危险因素,HDL-C是PB和FPA的共同保护因素,LDL-C是FP的危险因素,服用他汀史是PB的保护因素,高血压是NCA的危险因素。(5)二分类Logistic回归分析显示男性、糖尿病、Lp-PLA2、LDL-C和NCA是急性冠脉综合征发生的危险预测因素,ROC曲线显示Lp-PLA2及NCA具有较高的预测价值。结论:GHb A1C与Lp-PLA2是单支冠脉临界病变最重处PB、FPA及NCA的共同独立危险预测因素;胆固醇水平、高血压及服用他汀史对病变斑块性质的预测有一定预测价值;LP-PLA2以及NCA对单支冠脉临界病变患者急性冠脉综合征的发生有较高的预测价值。
[Abstract]:Objective: To study the single most critical coronary artery plaques composition associated with traditional cardiovascular risk factors and lipoprotein associated phospholipase A2 (Lipoprotein-associated phospholipase A2, Lp-PLA2) and the relationship between factors of plaque of coronary artery disease and its effect on stable angina and acute coronary syndrome difference between patients, to provide reference the estimation and treatment of coronary artery disease in patients with coronary heart disease clinical direction plaque. Methods: by retrospective analysis, a total of 192 patients with single coronary artery by coronary angiography showed critical stenosis lesions were divided into stable angina pectoris (Stable angina, pectoris, SAP) and 104 cases of patients with acute coronary syndrome (Acute coronary syndrome ACS, 88 cases), collect the most common cardiovascular risk factors and LP-PLA2 baseline data and compared the differences between the two groups. The I of MAP-IVUS Pro Circle of coronary atherosclerotic plaque were analyzed, the long axis images with 1mm spacing segmentation formation cross section, find the most serious stenosis and determined the minimal lumen area (minimum lumen, area, MLA), depicting the manual external elastic membrane interface and lumen interface, determination of the changes of 4 kinds of plaque formation area, namely fiber the plaque area (Fibrous plaque area, FPA), fiber (Fibro-fatty area, FFA fat area), necrosis (Necrotic core area, plaque area and plaque area (NCA) Dense calcium area calcification, DCA), the determination of the external elastic membrane area (Cross-sectional areas of vascular external elastic membrane EEMCSA areas (Cross-sectional), plaque area of plaque and media, PMCSA) and the calculation load (plaque burden, PB plaque index) and compared the differences between the two groups, the regression analysis of each index by using single factor and multivariate linear Close the prediction factors. Regression analysis to predict the factors of acute coronary syndrome occurred in two patients with coronary heart disease using Logistic classification, prediction value using ROC curve to evaluate the correlation of continuous variables and to calculate the critical value and the corresponding diagnostic sensitivity and specificity. Results: (1) compared with SAP group, ACS group had more patients with diabetes and smoking the higher the plasma concentration of Lp-PLA2 and low density lipoprotein cholesterol (Low-density lipoprotein, cholesterol, LDL-C) and low high density lipoprotein cholesterol (High-density lipoprotein, cholesterol, HDL-C), P values were less than 0.05. (2) compared with SAP group, ACS group of vascular lesions have higher EEMCSA, PMCSA. PB (Fibrous plaque area fiber plaque area, plaque area (FPA) and Necrotic core area necrosis, NCA), P values were less than 0.01. (3) single factor regression analysis, the risk of PB and FPA predictors of saccharification Hemoglobin (Glycated haemoglobin, GHb A1C (Triglycerides), triglyceride, total cholesterol (TG), Total cholesterol, TC), LDL-C and Lp-PLA2, statins and HDL-C history is the common protective factors of.NCA in predicting the risk factors including hypertension, age, GHb, A1C, TC, LDL-C and Lp-PLA2, HDL-C is a protective factor..FFA and DCA have no obvious correlation to predict the factors. A subgroup analysis of the SAP and ACS two respectively, plaque and plaque load prediction factors were not the same, see (4). After the regression analysis, after adjusting for other risk factors, GHb A1C and Lp-PLA2 is PB, FPA and NCA of the common risk HDL-C is a common factor, protection of PB and FPA, LDL-C is a risk factor for FP, statins history is a protective factor for PB, hypertension is the risk factor of NCA. (5) two classification Logistic regression analysis showed that male, diabetes, Lp-PLA2, LDL-C and NCA Is the risk factors predicting the incidence of acute coronary syndrome, ROC curve showed that the predictive value of Lp-PLA2 and NCA have high. Conclusion: GHb A1C and Lp-PLA2 is a single coronary artery lesion is the most critical weight at PB, FPA and the independent risk factors to predict common NCA; cholesterol level, hypertension and taking statins history to predict plaque lesions have certain predictive value; LP-PLA2 and NCA of single acute coronary syndrome patients with critical coronary lesions have a higher predictive value.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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