脂蛋白相关磷脂酶A2在急性冠脉综合征的临床意义及应用探讨

发布时间：2018-05-08 01:27

本文选题：脂蛋白相关磷脂酶A2 + 缺血修饰性白蛋白　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:近来,脂蛋白相关磷脂酶A2(LP-PLA2)受到越来越多心血管专家的关注,其被认为是与心肌损伤密切相关的生化指标,故本实验通过检测急性冠脉综合征(ACS)患者血清中LP-PLA2的含量变化,探讨LP-PLA2在ACS诊断的临床应用价值。因胸痛发作至入院时间不同,分析比较不同时间入院的ACS患者LP-PLA2浓度变化及其阳性率,探讨LP-PLA2,IMA,c Tn I三种生化指标优缺点及联合检测的意义。ACS患者体内伴随炎症反应,氧化应激增强,故统计分析LP-PLA2与hs CRP、氧化应激指标以及脂类生化指标(ACS的高危因素)的相关性。方法:收集2015年8月至2016年7月在吉林大学第一医院急诊内科和心内科住院并且临床资料完整的经过冠状动脉造影、心电图以及临床症状和体征已确诊为ACS患者血液标本153例作为实验组,按出现胸痛至入院时间的不同分为Ⅰ组(3 h)57例、Ⅱ组(3-6h)42例和Ⅲ组(6 h)54例。收集同期来自吉林大学第一医院体检中心的健康体检者血液标本50例为对照组,分别进行血清LP-PLA2、IMA、c Tn I、hs CRP、CHO、TG、LDLC、HDLC、APOA1、APOB、SOD和TAS检测,进行统计学分析。结果:1.实验组血清LP-PLA2、IMA、c Tn I、hs CRP均明显的高于对照组(p0.05),TAS、SOD明显低于对照组(p0.05),差异具有统计学意义。2.除实验Ⅲ组中IMA,实验Ⅰ组中c Tn I与对照组比较无统计学意义(p0.05)外,实验Ⅰ、Ⅱ、Ⅲ组中LP-PLA2、IMA、c Tn I、TAS、SOD、hs CRP各项指标分别与对照组比较,均升高明显(p0.05)。TAS、SOD、hs CRP三项指标分别在不同实验组间两两比较差异无统计学意义(p0.05),LP-PLA2、IMA、c Tn I三项指标在不同实验组间两两比较差异有统计学意义(p0.05)。3.实验Ⅰ、Ⅱ、Ⅲ组LP-PLA2、IMA、c Tn I阳性率与三项指标联合检测阳性率之间的比较差异有统计学意义(p0.05)。4.LP-PLA2与TG(r=0.951,p0.01)、CHO(r=0.961,p0.01)、LDLC(r=0.902,p0.01)、APOB(r=0.935,p0.01)、hs CRP(r=0.48,0.01p0.05)呈正相关;与HDLC(r=0.03,p0.01)、APOA1(r=0.112,p0.01)无相关性;与SOD(r=-0.689,p0.01)、TAS(r=-0.75,p0.01)呈负相关。结论:1.LP-PLA2浓度在ACS患者血清中升高,且在早期明显升高。2.LP-PLA2特异度明显高于IMA,其灵敏度显著优于c Tn I,与IMA、c Tn I联合检测能够更好地辅助临床对ACS的诊断。3.LP-PLA2与CHO、TG、LDLC、APOB、hs CRP呈正相关;LP-PLA2与SOD、TAS呈负相关。
[Abstract]:Objective: Recently, lipoprotein related phospholipase A2 (LP-PLA2) is concerned by more and more cardiovascular experts. It is considered to be a biochemical marker closely related to myocardial injury. Therefore, the clinical application value of LP-PLA2 in the diagnosis of ACS was explored by detecting the changes of the serum LP-PLA2 content in the patients with acute coronary syndrome (ACS). The clinical value of LP-PLA2 in the diagnosis of ACS was discussed. The changes in the concentration of LP-PLA2 and the positive rate of ACS patients at different time of admission were analyzed and compared. The advantages and disadvantages of the three biochemical indexes of LP-PLA2, IMA, C Tn I and the significance of combined detection were discussed. The inflammatory response and oxidative stress were enhanced in.ACS patients, and the results were divided into LP-PLA2 and HS CRP, oxidative stress indicators and lipid biochemistry. The correlation of the index (high risk factors of ACS). Methods: from August 2015 to July 2016, a total of 153 cases of ACS patients were treated with coronary angiography, electrocardiogram, clinical symptoms and signs, which were hospitalized in emergency internal medicine and Department of Cardiology in No.1 Hospital of Jilin University and the clinical data were complete. The difference of hospital time was divided into group I (3 h) 57 cases, group II (3-6h) 42 cases and group III (6 h) 54 cases, and 50 cases of blood samples from physical examination center of No.1 Hospital of Jilin University were collected for the control group, and the serum LP-PLA2, IMA, C Tn I, HS CRP, CHO, TG, TG, dialectical and statistical analysis were carried out, and the results were statistically analyzed. Results: 1. The serum LP-PLA2, IMA, C Tn I and HS CRP were significantly higher than those of the control group (P0.05), TAS and SOD significantly lower than the control group (P0.05). Compared with the control group, the three indexes of P0.05.TAS, SOD and HS CRP were not statistically significant between the different experimental groups (P0.05), LP-PLA2, IMA, C Tn I three indexes were statistically significant (P0.05) among the different experimental groups (P0.05). P0.05.4.LP-PLA2 and TG (r=0.951, P0.01), CHO (r=0.961, P0.01), LDLC (r=0.902, P0.01) are positively related; Negative correlation. Conclusion: the concentration of 1.LP-PLA2 increased in the serum of ACS patients, and the specificity of.2.LP-PLA2 was significantly higher in the early stage than that of IMA, and its sensitivity was significantly better than that of C Tn I. The joint detection of IMA and C Tn I was better than that of IMA and C Tn I.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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