天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (7): 746-750.doi: 10.11958/20180140

• 诊断技术 • 上一篇    下一篇

脂蛋白相关磷脂酶A2与冠状动脉支架术后再狭窄的关系

朱慎慎△，吴照科，胡艳敏   

  1. 朱慎慎（1986），女，硕士，主治医师，主要从事心血管病的基础与临床研究
  • 收稿日期:2018-01-24 修回日期:2018-05-22 出版日期:2018-07-15 发布日期:2018-07-15
  • 通讯作者: 朱慎慎 E-mail:1004928796@qq.com
  • 作者简介:朱慎慎（1986），女，硕士，主治医师，主要从事心血管病的基础与临床研究

Relationship between plasma lipoprotein associated phospholipase A2 and coronary in-stent restenosis after percutaneous coronary intervention

ZHU Shen-shen△, WU Zhao-ke, HU Yan-min   

  1. Department of Geriatrics, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China △Corresponding Author E-mail: 1004928796@qq.com
  • Received:2018-01-24 Revised:2018-05-22 Published:2018-07-15 Online:2018-07-15

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摘要： 目的 探讨血浆脂蛋白相关磷脂酶A2（Lp-PLA2）水平与冠状动脉支架置入术后支架内再狭窄（ISR）的相 关性。方法 选取208例在我院行经皮冠状动脉介入治疗（PCI）并于术后复查冠状动脉造影的患者，根据冠状动脉 造影结果分为ISR组（29例）和支架内无再狭窄（NISR）组（179例），2组均于首次PCI前及复查冠状动脉造影时检测 血浆Lp-PLA2水平，比较2组间一般临床资料、生化指标、冠状动脉病变情况、支架置入情况及血浆Lp-PLA2水平的 差异；Logistic回归分析ISR发生的独立危险因素；受试者工作特征曲线（ROC）评价血浆Lp-PLA2水平（ΔLp-PLA2， 复诊时Lp-PLA2水平-首次PCI术前Lp-PLA2水平）对ISR发生的预测能力。结果 （1）ISR组较NISR组2型糖尿病 患者比例升高，低密度脂蛋白胆固醇（LDL-C）及糖化血红蛋白（HbA1c）水平升高，总胆红素（T-BIL）水平降低，使用 支架长度偏长，支架直径偏小（P＜0.05）。（2）ISR组首次PCI术前、复诊时Lp-PLA2水平及ΔLp-PLA2均较NISR组升 高（P＜0.05）。（3）Logistic回归分析显示T-BIL升高、支架直径增加、ΔLp-PLA2增加是ISR的独立危险因素。（4）ROC 曲线分析结果显示，△Lp-PLA2预测ISR的曲线下面积为0.862，最佳预测值为20.68 μg/L，敏感度为79%，特异度为 83%。结论 PCI术后血浆Lp-PLA2水平的升高与ISR相关，定期监测血浆Lp-PLA2水平对预测ISR具有一定意义。

关键词: 冠心病, 脂蛋白相关磷脂酶A2, 经皮冠状动脉介入治疗, 支架内再狭窄

Abstract: Objective To investigate the relationship between plasma lipoprotein associated phospholipase A2 (LpPLA2) level and in-stent restenosis (ISR) after percutaneous coronary intervention (PCI). Methods A total of 208 patients treated with PCI and examined with a follow-up coronary angiograph (CAG) were included in this study. The patients were divided into 2 groups based on the results of ISR condition: ISR group (n=29) and NISR group (n=179). The plasma levels of Lp-PLA2 were detected before first-PCI operation and follow-up CAG in two groups. The general clinical data, biochemical parameters, coronary coronariography, interventional features and plasma levels of Lp-PLA2 were compared between the two groups. Logistic regression analysis was used to analyze the independent risk factor for ISR. Receiver operating characteristic curve was used to evaluate the predictive ability of the plasma level of Lp-PLA2 to the occurrence of ISR. Results (1) In ISR group, patients with the history of type 2 diabetes, levels of low density lipoprotein cholesterol (LDL-C) and levels of glycosylated hemoglobin (HbA1c) were significantly higher than those in NISR group, while serum levels of total bilirubin (T- BIL) decreased, the length of the stent was longer, and stent diameter was smaller (P＜0.05). (2) In ISR group, the Lp-PLA2 level and ΔLp-PLA2 level were higher before first-PCI operation than those in NISR group (P＜0.05). (3) Logistic regression analysis showed that T-BIL, stent diameter and ΔLp-PLA2 were the independent risk factors for ISR (P＜0.05). (4) The receiver operating characteristic curve (ROC) area of ΔLp-PLA2 for predicting post-PCI ISR occurrence was 0.862, the optimal cut off value of ΔLp-PLA2 was 20.68 μg/L, the sensitivity was 79%, and the specificity was 83%. Conclusion The increased level of Lp-PLA2 after PCI is correlated with ISR, and the regular monitoring the level of Lp-PLA2 has some significance in forecasting ISR.

Key words: coronary heart disease, lipoprotein associated phospholipase A2, percutaneous coronary intervention, instent restenosis