血清中Lp-PLA2、RBP、Hcy和ox-LDL联合检测在50岁以下急性冠脉综合征患者诊断和预后中的价值

张静; 贺志安

doi:10.12019/j.issn.1671-5144.2020.06.005

血清中Lp-PLA2、RBP、Hcy和ox-LDL联合检测在50岁以下急性冠脉综合征患者诊断和预后中的价值

张静^1,2,3,
贺志安^1, ,

1.
新乡医学院医学检验学院,河南新乡 453000
2.
河南省免疫与靶向药物重点实验室、河南省分子诊断与医学检验技术协同创新中心,河南新乡 453000
3.
新乡市中心医院检验科, 河南新乡 453000

详细信息

作者简介:
张静（1994-）,女,河南郑州人,住院医师,医学硕士,研究方向为心血管疾病的实验诊断学。

通讯作者:
贺志安,Tel: 0373-3029977, E-mail: 309378297@qq.com。

中图分类号: R541.4;R446.11
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出版历程
- 收稿日期: 2020-12-07
- 发布日期: 2020-12-27

The Value of Combined Detection of Lp-PLA2, RBP, Hcy and ox-LDL in Serum for the Diagnosis and Prognosis of Acute Coronary Syndrome Patients Under 50 Years Old

ZHANG Jing^1,2,3,
HE Zhi-an^1, ,

1.
Xinxiang Medical College of Laboratory Medicine, Xinxiang Henan 453000, China
2.
Henan Provincial Key Laboratory of Immunology and Targeted Drugs, Henan Provincial Collaborative Innovation Center of Molecular Diagnosis and Medical Examination Technology, Xinxiang Henan 453000, China
3.
Clinical Laboratory of Xinxiang Central Hospital, Xinxiang Henan 453000, China

摘要

摘要: 目的探究脂蛋白相关磷脂酶A2（lipoprotein-related phospholipase,Lp-PLA2）、视黄醇结合蛋白（retinol binding protein,RBP）、血清同型半胱氨酸（homocysteine,Hcy）以及血浆氧化修饰低密度脂蛋白（oxidized low-density lipoprotein,ox-LDL）联合检测在50岁以下急性冠脉综合征（acute coronary syndrome,ACS）患者诊断和预后中的价值。方法选择2018年1月到2019年12月收治经冠状动脉造影确诊的90例ACS患者作为研究对象,其中急性心肌梗死（acute myocardial infarction,AMI）患者40例,不稳定型心绞痛（unstable angina pectoris,UAP）患者50例,另选择同期于医院体检健康的志愿者80例作为对照组。收集所有研究对象临床资料,并随访6个月后ACS患者不良心血管事件（major adverse cardiovascular events,MACE）发生情况。Pearson相关性分析ACS患者Lp-PLA2、RBP、Hcy和ox-LDL水平与Gensini积分的相关性。多因素logistic分析MACE发生的危险因素,受试者工作曲线（receiver operating curve,ROC）分析Lp-PLA2、RBP、Hcy和ox-LDL单独和联合预测ACS预后中的价值并进行一致性检验。结果与UAP组和对照组相比,AMI组左心室射血分数值（left ventricular ejection fraction,LVEF）明显降低,Gensini积分、Lp-PLA2、RBP、Hcy和ox-LDL明显升高;ACS患者Lp-PLA2、RBP、Hcy和ox-LDL水平与Gensini积分呈明显正相关。Gensini积分、Lp-PLA2、RBP、Hcy和ox-LDL是MACE发生的独立危险因素;联合血清中Lp-PLA2、RBP、Hcy和ox-LDL对ACS患者预后具有较好的诊断价值（曲线下面积为0.919,灵敏度为93.9%,特异度为92.4%）,预测模型与实际值具有较高的一致性,上述差异均具有统计学意义（P<0.05）。结论 Lp-PLA2、RBP、Hcy、ox-LDL水平可作为诊断冠状动脉病变程度生化标志物,且四者联合对ACS患者的预后具有较好的预测价值。
- 急性冠脉综合征 /
- 脂蛋白相关磷脂酶 /
- 视黄醇结合蛋白 /
- 血清同型半胱氨酸 /
- 氧化修饰低密度脂蛋白
Abstract: Objective To explore the value of combined detection of lipoprotein-related phospholipase A2（Lp-PLA2）, retinol binding protein （RBP）, serum homocysteine （Hcy）, and plasma oxidized low-density lipoprotein （ox-LDL） in the diagnosis and prognosis of acute coronary syndrome （ACS） patients under 50 years old. Methods 90 ACS patients diagnosed by coronary angiography from January 2018 to December 2019 were selected as the research objects, including 40 acute myocardial infarction （AMI） patients and 50 unstable angina pectoris （UAP） patients, and 80 volunteers who had physical examination in our hospital at the same time were selected as the control group. We collected and recorded the clinical data and biochemical indicators, left ventricular ejection fraction （LVEF） and Gensini scores of all study subjects. The pearson correlation analysis was used between Gensini score and Lp-PLA2, RBP, Hcy, ox-LDL levels in ACS patients, the multivariate logistic analysis was used to analyze the risk factors of major adverse cardiovascular events （MACE）, the receiver operating curve （ROC） was used to analyze the value of Lp-PLA2, RBP, Hcy and ox-LDL in the prognosis of ACS, and consistency test was conducted. Results The LVEF of the AMI group was significantly lower than that of the UAP group and the control group, the Gensini score, the levels of Lp-PLA2, RBP, Hcy, and ox-LDL were significantly higher than that of the UAP group and the control group（P<0.05）. Pearson correlation analysis results showed that the levels of Lp-PLA2, RBP, Hcy and ox-LDL in ACS patients were positively correlated with the Gensini score. Gensini score, Lp-PLA2, RBP, Hcy and ox-LDL are independent risk factors for MACE （P<0.05）. ROC curve analysis showed that the combination of Lp-PLA2, RBP, Hcy and ox-LDL had a good diagnostic value for the prognosis of ACS patients （area under curve 0.919, sensitivity 93.9%, specificity 92.4%）. The prediction model had high consistency with the actual value. Conclusions The levels of Lp-PLA2, RBP, Hcy and ox-LDL could be used as biochemical markers for the diagnosis of coronary artery disease, and the combination of them had relatively accurate predictive value for the prognosis of ACS patients.
- acute coronary syndrome /
- lipoprotein-associated phospholipase /
- retinol binding protein /
- serum homocysteine /
- oxidized modified low density lipoprotein

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参考文献(25)

[1]	LIU Y Q.Prevalence and risk factors of coronary heart disease in Jinchang cohort[D]. Lanzhou University, 2016. [刘燕青. 金昌队列人群冠心病的患病状况及危险因素研究[D]. 兰州大学, 2016. ]
[2]	YAO B Q, HUANG S T, GE J L, et al.Research progress on risk factors of progression and control strategy of non-culprit coronary lesions in post-PCI patients with acute coronary syndrome[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2020, 28(6): 94-99. [姚冰琪, 黄淑田, 葛婕丽, 等. 急性冠脉综合征患者经皮冠状动脉介入治疗后非罪犯血管病变进展危险因素及防治策略的研究进展[J]. 实用心脑肺血管病杂志, 2020, 28(6): 94-99. ]
[3]	LI H D, ZHANG J R, MA Q H.Correlation between combined detection of serum hscTnT, Hcy and hsCRP and diagnostic positive rates of coronary heart disease[J]. Chinese Journal of Cardiovascular Rehabilitation Medicine, 2018, 27(6): 667-671. [李海德, 张俊然, 马清华. 血清hscTnT、Hcy、hsCRP联合检测与冠心病诊断阳性率的相关性[J]. 心血管康复医学杂志, 2018, 27(6): 667-671. ]
[4]	CHEN X.Analysis of the value of combined detection of Hcy, serum bilirubin and lipoprotein(a) in the diagnosis of coronary heart disease[J]. Contemporary Medicine, 2018, 24(32): 89-91. [陈霞. Hcy与血清胆红素与脂蛋白(a)联合检验在冠心病患者诊断中的应用价值分析[J]. 当代医学, 2018, 24(32): 89-91. ]
[5]	SAIRAM S G, SOLA S, BAROOAH A, et al.The role of Lp-PLA2 and biochemistry parameters as potential biomarkers of coronary artery disease in Asian South-Indians: A case-control study[J]. Cardiovasc Diagn Ther, 2017, 7(6): 589-597.
[6]	PEI D X, LI Y W, LIU X W.Significance of combined detection of HCY, Lp-PLA2 and CysC in elderly stroke patients[J]. Chinese Journal of Gerontology, 2019, 39(2): 273-275. [裴东旭, 李永伟, 刘心伟. 老年脑卒中患者HCY、Lp-PLA2和CysC联合检测的意义[J]. 中国老年学杂志, 2019, 39(2): 273-275. ]
[7]	CAO J F, SUN Y X, LI D.Change of serum RBP-4 level in patients with coronary heart disease and its correlation with the severity of coronary artery lesions[J]. Hainan Medical Journal, 2017, 28(17): 2779-2781. [曹健锋, 孙艳霞, 李丹. 冠心病患者血清RBP-4水平变化及其与冠状动脉病变严重程度的相关性[J]. 海南医学, 2017, 28(17): 2779-2781. ]
[8]	Chinese Society of Cardiology, Editorial Committee of Chinese Journal of Cardiology. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndrome (2016)[J]. Chinese Journal of Cardiology, 2017, 45(5): 359-376. [中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 非ST段抬高型急性冠状动脉综合征诊断和治疗指南(2016)[J]. 中华心血管病杂志, 2017, 45(5): 359-376. ]
[9]	WANG J.Effects of health education intervention on the quality of life of patients with acute coronary syndrome[J]. Cardiovascular Disease Journal of Integrated Traditional Chinese and Western Medicine(Electronic), 2020, 8(10): 156-157. [王娇. 健康教育干预对急性冠状动脉综合征患者生活质量的影响[J]. 中西医结合心血管病电子杂志, 2020, 8(10): 156-157. ]
[10]	MOREIRA H G, LAGE R L, MARTINEZ D G, et al.Sympathetic nervous activity in patients with acute coronary syndrome: A comparative study of inflammatory biomarkers[J]. Clin Sci (Lond), 2017, 131(9): 883-895.
[11]	YANG F M, MA L P, ZHANG L L, et al.Association between serum lipoprotein-associated phospholipase A2, ischemic modified albumin and acute coronary syndrome: A cross-sectional study[J]. Heart Vessels, 2019, 34(10): 1608-1614.
[12]	ALTUNKESER B B, TUNCEZ A, OZTURK B, et al.Comparative effects of high-dose atorvastatin versus rosuvastatin on lipid parameters, oxidized low-density lipoprotein, and proprotein convertase subtilisin kexin 9 in acute coronary syndrome[J]. Coron Artery Dis, 2019,30(4): 285-290.
[13]	SHI R R, WANG Z H.Clinical value evaluation of joint detection of lipoprotein associated phospholipase A2 and small dense low-density lipoprotein cholesterol levels in the diagnosis of patients with coronary heart disease[J]. International Journal of Laboratory Medicine, 2018, 39(12): 1421-1428. [施蓉蓉,汪占华. 脂蛋白相关磷脂酶A2和小而密低密度脂蛋白胆固醇联合检测在冠心病患者诊断中的临床价值评价[J]. 国际检验医学杂志, 2018, 39(12): 1421-1428. ]
[14]	SONG W T.Prognostic value of lipoprotein-associated phospholipase A2 on short-term adverse outcomes in patients with acute coronary syndromes[D]. Tianjin Medical University, 2016. [宋温婷. 血浆脂蛋白相关性磷脂酶A2对急性冠脉综合征患者早期预后的预测价值[D]. 天津医科大学, 2016. ]
[15]	QIN M M, HUANG Y X, CHEN X M, et al.The value of combined detection of LP-PLA2 and sd-LDL in the auxiliary diagnosis of atherosclerosis[J]. Chinese Journal of Laboratory Medicine, 2019, 42(1): 38-43. [秦明明, 黄雨馨, 陈雪梅, 等. Lp-PLA2与sd-LDL联合检测对动脉粥样硬化的辅助诊断价值[J]. 中华检验医学杂志, 2019, 42(1): 38-43. ]
[16]	FU J P, ZHANG Y, XU B, et al.Correlation among serum ischemic modified albumin, homocysteine and coronary atherosclerotic heart disease and the diagnostic value of combined detection[J]. China Medicine, 2019, 14(5): 664-668. [付建平, 张羽, 徐彬, 等. 血清缺血修饰白蛋白和同型半胱氨酸与冠状动脉粥样硬化性心脏病的相关性及联合检测对疾病的临床诊断价值[J]. 中国医药, 2019, 14(5): 664-668. ]
[17]	TANG W B.A correlation analysis of serum D-dimer, Hcy and sd-LDL in elderly patients with coronary heart disease[J]. Clinical Journal of Chinese Medicine, 2018, 10(35): 16-18. [唐文博. 老年冠心病患者血清D-二聚体、Hcy与sd-LDL的相关性研究[J]. 中医临床研究, 2018, 10(35): 16-18. ]
[18]	CHEN S S, CHEN Q H, LI X D.Changes and clinical significance of serum homocysteine and high-sensitivity C-reactive protein in hypertension and coronary heart disease[J]. Hainan Medical Journal, 2017, 28(5): 769-771. [陈珊珊, 陈巧红, 李心德. 高血压、冠心病患者血清同型半胱氨酸和超敏C反应蛋白水平的变化及临床意义[J]. 海南医学, 2017, 28(5): 769-771. ]
[19]	ZHAO X M, GAO L, LIU Y.Application of combined detection of serum homocysteine and high sensitive cardiac troponin T in diagnosis of coronary artery disease[J]. Journal of China Medical University, 2017, 46(1): 59-61. [赵晓萌, 高雷, 刘勇. 血清同型半胱氨酸与超敏肌钙蛋白T联合检测在冠状动脉粥样硬化性心脏病诊断中的应用[J]. 中国医科大学学报, 2017, 46(1): 59-61. ]
[20]	HAN Y, WANG S, HUANG C, et al.Correlation analysis of serum Lp-PLA2 with Hcy, hsCRP and biochemical indexes in patients with acute ischemic stroke[J]. Chinese Journal of Emergency Medicine, 2019, 28(8): 1026-1028. [韩媛, 王爽, 黄超, 等. 急性缺血性脑卒中患者血清Lp-PLA2与Hcy、hsCRP及生化指标的相关性分析[J]. 中华急诊医学杂志, 2019, 28(8): 1026-1028. ]
[21]	LI J, HUANG X M, JIANG Y Z, et al.Expression and clinical significance of serum retinol binding protein 4, superoxide dismutase and hypersensitive C-reactive protein in patients with acute ST-segment elevated myocardial infarction[J]. Chinese Critical Care Medicine, 2020, 32(10): 1199-1202. [李静, 黄晓明, 姜友珍, 等. 联合检测RBP4和SOD及hs-CRP在急性ST段抬高型心肌梗死中的表达及意义[J]. 中华危重病急救医学, 2020, 32(10): 1199-1202. ]
[22]	HU J W, YU H Y, LIU X X, et al.Correlation between visfatin, retinol binding protein 4 and coronary heart disease[J]. Modern Preventive Medicine, 2020, 47(1): 181-184. [胡剑威, 于洪尧, 刘欣欣, 等. 内脂素、视黄醇结合蛋白4与冠心病的相关性分析[J]. 现代预防医学, 2020, 47(1): 181-184. ]
[23]	CAO J Q, DING Y Y, ZHENG H C.The association between serum retinol binding protein 4 and in-stent restenosis after percutaneous coronary intervention[J]. Prevention and Treatment of Cardio-Cerebral-Vascular Disease, 2020, 20(1): 80-82. [曹佳齐, 丁跃有, 郑宏超. 血清视黄醇结合蛋白4与冠状动脉支架植入术后再狭窄的相关性分析[J]. 心脑血管病防治, 2020, 20(1): 80-82. ]
[24]	ZHU J P, ZHU L R.Association among oxidized low density lipoprotein and the expression of Notch1, Notch2 in CD4+T cells in patients with acute coronary syndrome[J]. Tianjin Journal of Traditional Chinese Medicine, 2019, 36(9): 865-868. [朱家平, 朱李茹. 氧化型低密度脂蛋白与急性冠状动脉综合征患者CD4+T细胞Notch1、Notch2表达的相关性研究[J]. 天津中医药, 2019, 36(9): 865-868. ]
[25]	SONG X Y, GAO B, DONG H.Correlation between serum APN, HO-1, Ox-LDL and severity of coronary artery stenosis in patients with acute coronary syndrome[J]. Journal of Clinical and Experimental Medicine, 2016,15(22): 2228-2232. [宋小英, 高波, 董晗. 急性冠状动脉综合征患者血清APN、HO-1、Ox-LDL水平与冠状病变程度的相关性分析[J]. 临床和实验医学杂志, 2016, 15(22): 2228-2232. ]

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