脂蛋白相关性磷脂酶A2在冠心病及房颤患者中的价值

发布时间：2018-07-23 08:16

【摘要】：目的:(1)研究影响患者血浆脂蛋白相关性磷脂酶A2(Lp-PLA2)水平的临床因素,证实Lp-PLA2与冠心病(CHD)的相关关系,探讨其在行经皮介入治疗(PCI)的CHD患者近期预后中的价值。(2)研究不同类型心房颤动(AF)患者Lp-PLA2水平,及其与Lp-PLA2之间的关系,探讨Lp-PLA2在房颤中的作用机制。方法:(1)入选怀疑CHD患者662例,对入选患者行冠状动脉造影(CAG)检查,依造影结果将患者分为冠心病组(n=460)、非冠心病组(n=202)。分别以是否接受PCI治疗以及PCI治疗患者中是否有MACE发生为标准分出亚组,即PCI治疗组和非PCI治疗组,MACE组和非MACE组。检测各组患者血液生化指标及心脏超声结果,记录患者基本临床资料及随访期间内有无MACE发生,对各变量与CHD、PCI治疗及PCI治疗后MACE的关系作logistic回归分析。(2)将入选的122例AF患者分为阵发性房颤组(A,n=38),持续性房颤组(B,n=40),永久性房颤组(C,n=44),随机选取41例窦性心律患者为对照组(D),记录患者临床资料及检测指标。结果:(1)Lp-PLA2水平于CHD患者中明显高于非CHD患者,在PCI治疗组高于非PCI治疗组,用Lp-PLA2诊断CHD的最佳值为231.85ng/ml。(2)回归分析发现①Lp-PLA2是CHD患病以及CHD患者需要接受PCI治疗的危险因素(OR 1.066,95%CI1.051-1.082,OR 1.008,95%CI1.000-1.015);②Lp-PLA2(OR 1.003,95%CI1.017-1.048)、射血分数(OR 1.864,95%CI0.751-1.995)、剩余Gensini积分(OR 1.079,95%CI1.062-1.097)及冠心病类型(OR 3.949,95%CI1.126-13.857)是接受PCI治疗的CHD患者近期MACE的危险因素。(3)Lp-PLA2与LDL-C(r=0.316)、剩余Gensini积分(r=0.357)、病变血管支数(r=0.714)、hs-CRP(r=0.488)、动脉粥样硬化指数(r=0.261)、血糖浓度(r=0.192)及纤维蛋白原(r=0.268)呈正相关;与HDL-C(r=-0.250)、CO2CP(r=-0.134)、WBC(r=-0.219)呈负相关。(4)Lp-PLA2与hs-CRP水平在持续性房颤组及永久性房颤组明显高于阵发性房颤组及对照组(p0.05)。LAD在永久性房颤组及持续性房颤组大于阵发性房颤组和对照组(p0.05)。(5)阵发房颤组中hs-CRP与LAD成正相关,持续性房颤组及永久性房颤组中Lp-PLA2、hs-CRP与LAD均呈正相关。结论:①Lp-PLA2水平于CHD患者中明显高于非CHD患者,PCI治疗组高于非PCI治疗组,PCI术后有MACE发生者高于无MACE者;②检测Lp-PLA2水平对拟诊CHD患者的诊断和PCI术后患者近期预后有重要预测价值;③Lp-PLA2水平与LDL-C hs-CRP、动脉粥样硬化指数、血糖、纤维蛋白原呈正相关,与HDL-C、CO2CP、WBC呈负相关。
[Abstract]:Objective: (1) to study the clinical factors influencing plasma lipoprotein associated phospholipase A 2 (Lp-PLA2) and to confirm the relationship between Lp-PLA2 and coronary heart disease (CHD). To investigate the value of Lp-PLA2 in the short-term prognosis of CHD patients undergoing percutaneous intervention (PCI). (2) to study the level of Lp-PLA2 in patients with different types of atrial fibrillation (AF) and its relationship with Lp-PLA2, and to explore the mechanism of Lp-PLA2 in atrial fibrillation. Methods: (1) 662 patients with suspected CHD were examined by coronary angiography (CAG). The patients were divided into coronary heart disease group (n = 460) and non-coronary heart disease group (n = 202). The patients were divided into two subgroups according to whether or not they received PCI and whether there was Mace in PCI patients, that is, PCI treatment group and non-PCI treatment group, Mace group and non-MACE group. The blood biochemical indexes and the results of echocardiography were detected, and the basic clinical data of the patients and whether Mace occurred during the follow-up period were recorded. Logistic regression analysis was used to analyze the relationship between variables and Mace after PCI. (2) one hundred and twenty-two patients with AF were divided into three groups: paroxysmal atrial fibrillation group (An 38), persistent atrial fibrillation group (n = 40) and permanent atrial fibrillation group (C n = 44). 41 patients with sinus rhythm were randomly selected as control group. In group D, the clinical data and detection indexes were recorded. Results: (1) the level of Lp-PLA2 in CHD patients was significantly higher than that in non-CHD patients, and was higher in PCI group than in non-PCI group. The best value of Lp-PLA2 in the diagnosis of CHD was 231.85 ng / ml. (2) the regression analysis found that 1Lp-PLA2 was the risk factor for CHD and for patients with CHD requiring PCI (OR 1.066 / 95CI1.051-1.082OR 1.008 / 95CI1.000-1.015), 2Lp-PLA2 (OR 1.003t95CI1.017-1.048), ejection fraction (OR 1.86495 CI0.751-1.995), the remaining Gensini score (OR 1.0799595CI1.062-1.097) and the type of coronary heart disease (OR 3.99495 CI1.126-13.857) were accepted as well as the remaining Gensini score (OR 1.07995 95 CI 1.062-1.097) and the type of coronary heart disease (OR 3.994 95 CI 1.126-13.857). (3) Lp-PLA2 was positively correlated with LDL-C (r-0.316), residual Gensini score (r-0.357), the number of diseased vessels (r-0.714), hs-CRP (r-0.488), atherosclerosis index (r-0.261), blood glucose concentration (r0.192) and fibrinogen (r-0.268). (4) the levels of Lp-PLA2 and hs-CRP in persistent atrial fibrillation group and permanent atrial fibrillation group were significantly higher than those in paroxysmal atrial fibrillation group and control group (p0.05). Lad in permanent atrial fibrillation group and persistent atrial fibrillation group was higher than that in paroxysmal atrial fibrillation group and control group (p0.05). (5). There was a positive correlation between hs-CRP and lad in the fibrillation group. There was a positive correlation between Lp-PLA _ 2 hs-CRP and lad in patients with persistent atrial fibrillation and permanent atrial fibrillation. Conclusion the level of% 1Lp-PLA2 in CHD patients was significantly higher than that in non-CHD patients treated with PCI, and the incidence of Mace in non-PCI patients was higher than that in patients without Mace. 2Detection of Lp-PLA2 level has important predictive value in the diagnosis of CHD patients and the short-term prognosis of patients after PCI. The level of Lp-PLA2 is positively correlated with LDL-C hs-CRPP, atherosclerosis index, blood glucose and fibrinogen, and negatively correlated with HDL-CnCO2CPP WBC.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4;R541.75

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