脂蛋白相关磷脂酶A2与冠状动脉斑块特征相关分析

Correlation analysis of lipoprotein-associated phospholipase A2 and coronary artery plaque characteristics

摘要:

目的 探讨冠心病患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)与冠状动脉斑块特征的关系。方法 回顾性分析2015年7月至2016年7月郑州大学第五附属医院和第一附属医院心血管内科行冠状动脉造影(CAG)检查和血管内超声(IVUS)检查的冠心病患者165例,根据IVUS结果分为稳定斑块组86例和易损斑块组79例,比较2组患者生化指标、IVUS指标和Lp-PLA2水平,分析Lp-PLA2水平与斑块特征的相关性。采用SPSS 17.0统计软件对数据进行分析。组间比较采用t检验或χ²检验,单因素分析采用Pearson直线相关分析,logistic回归分析影响斑块稳定的危险因素。结果 易损斑块组相比稳定斑块组斑块负荷[(58.20±13.59)% vs(54.72±9.98)%]、血管重塑指数[(1.61±0.32) vs(1.13±0.26)]、斑块偏心指数[(1.58±0.15) vs(1.48±0.36)]和坏死组织[(25.1±9.9)% vs(12.3±7.5)%]以及钙化组织[(6.5±3.5)% vs(0.8±0.4)%]所占比例增高,纤维帽厚度[(0.60±0.27) vs(0.75±0.31)mm]、纤维化脂质组织[(17.0±5.6)% vs(20.2±6.1)%]和纤维组织[(59.9±7.5)% vs(62.2±7.1)%]比例降低,差异具有统计学意义(P<0.05)。 Lp-PLA2水平与斑块成分中坏死组织(r=0.514)、斑块负荷(r=0.395)、血管重塑指数(r=0.832)、斑块偏心指数(r=0.904)成正相关,与纤维帽厚度(r=-0.710)成负相关,差异具有统计学意义(P<0.05)。 斑块稳定性的危险因素为高血压(OR=6.82,95%CI 2.16～21.46,P=0.01)、糖尿病(OR=2.65,95%CI 1.02～6.74,P=0.04)、吸烟史(OR=1.25,95%CI 1.06～1.62,P＜0.01)、低密度脂蛋白胆固醇(OR=1.36,95%CI 1.10～1.76,P＜0.01)、Lp-PLA2(OR=10.69,95%CI 1.72～66.91,P=0.001)。结论 Lp-PLA2水平可作为评估冠状动脉斑块是否稳定的敏感指标。

Abstract:

Objective To investigate the relationship of serum lipoprotein-associated phospholipase A2 (Lp-PLA2) and the characteristics of coronary artery plaque among the patients of coronary heart disease. Methods A total of 165 patients with coronary heart diseases who underwent coronary angiography (CAG) and intravascular ultrasound (IVUS) in our 2 departments from July 2015 to July 2016 were enrolled in this study. According to the findings, the patients were divided into stable plaque group (n=86) and vulnerable plaque group (n=79). The biochemical indicators, parameters of IVUS and serum Lp-PLA2 level were observed, and correlation between Lp-PLA2 and plaque features were analyzed. SPSS statistics 17.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for the comparison between the 2 groups. Pearson linear correlation analysis was used for single factor analysis, and logistic regression analysis was adopted for the risk factors affecting plaque stability. Results Compared with the stable plaque group, the vulnerable plaque group had higher plaque burden [(58.20±13.59)% vs(54.72±9.98)%], vascular remodeling index [(1.61±0.32) vs (1.13±0.26)], and plaque eccentricity index [(1.58±0.15) vs (1.48±0.36)], larger percentages of necrotic tissue [(25.1±9.9)% vs (12.3±7.5)%] and calcified tissue [(6.5±3.5)% vs (0.8±0.4)%], thinner fibroatheroma cap thickness [(0.60±0.27) vs (0.75±0.31) mm] and lower percentages of fibro-lipid tissue [(17.0±5.6)% vs (20.2±6.1)%] and fibrous tissue [(59.9±7.5)% vs (62.2±7.1)%] (all P<0.05). The serum level of Lp-PLA2 was positively correlated with percentage of plaque necrotic tissue (r=0.514), plaque burden (r=0.395), vascular remodeling index (r=0.832), plaque eccentricity index (r=0.904), but negatively with fibroatheroma cap thickness (r=-0.710) (all P<0.01). The significant risk factors for plaque stability were hypertension (OR=6.82,5%CI 2.16-21.46, P=0.01), diabetes mellitus (OR=2.65,5%CI 1.02-6.74, P=0.04), history of smoking (OR=1.25,5%CI 1.06-1.62, P<0.01), and serum levels of LDL-L (OR=1.36,5%CI 1.10-1.76, P<0.01) and Lp-PLA2 (OR=10.69,5%CI 11.72-66.91, P=0.001). Conclusion The serum Lp-PLA2 level can be used as a sensitive index in evaluation of the instability of coronary artery plaque.