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首页> 中文期刊> 《西安交通大学学报（医学版）》 >非ST段抬高ACS患者血浆 sCD40L和Lp-PLA2水平对冠脉病变程度及危险性的评估价值

非ST段抬高ACS患者血浆 sCD40L和Lp-PLA2水平对冠脉病变程度及危险性的评估价值

         
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Objective To investigate the clinical significance of soluble CD40 ligand (sCD40L ) and lipoprotein associated phospholipase A2 (Lp-PLA2 ) in the assessment of coronary artery severity and risk classification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Methods Of the 9 6 patients with coronary heart disease diagnosed by coronary angiography,2 8 patients had stable angina pectoris (SAP),38 patients unstable angina pectoris (UAP)and 30 patients acute non-ST-segment elevation myocardial infarction (NSTEMI).Another 30 patients with non-coronary heart disease (NC)served as controls.The sCD40L and Lp-PLA2 levels were determined by enzyme-linked immune sorbent assay (ELISA)method.The Gensini score was used to assess the severity of coronary artery and analyze the correlation with sCD40L and Lp-PLA2.The correlation of sCD40L and Lp-PLA2 with GRACE risk score was analyzed too.Results ① sCD40L was significantly higher in NSTEMI and UAP groups than in SAP and NC groups (P<0 .0 5 ),but there was no significant difference between NSTEMI and UAP groups (P>0 .0 5 )or SAP and NC groups (P>0 .0 5 ).Lp-PLA2 was significantly higher in NSTEMI group than in UAP,SAP and NC groups (P<0.05).Lp-PLA2 was significantly higher in UAP group than in SAP and NC groups (P<0.05).② We found that sCD40L had obvious correlation with Lp-PLA2 (r=0.284, P<0.01),Gensini score (r=0.213,P<0.05),and GRACE (r=0.224,P<0.05).Lp-PLA2 was significantly correlated with Gensini score (r=0.270,P<0.05),and GRACE (r=0.323,P<0.01).③ Multivariate logistic regression analysis showed that Lp-PLA2 was independently associated with NSTE-ACS (P<0.05).Conclusion The sCD40L and Lp-PLA2 which were significantly elevated in NSTE-ACS are correlated with the severity of coronary artery disease.The two indexes indicate the instability of atherosclerotic plaque;thus they can be used as predictors of risk assessment in coronary heart disease.%目的：研究非 ST段抬高急性冠脉综合征(NSTE-ACS)患者血浆可溶性 CD40配体(sCD40L)水平和脂蛋白相关磷脂酶 A2(Lp-PLA2)水平对冠心病危险性的评估价值。方法选取2014年9月至2015年3月住院并行冠脉造影确诊的冠心病患者96例,其中稳定型心绞痛(SAP)患者28例,不稳定型心绞痛(UAP)患者38例,急性非 ST段抬高心肌梗死(NSTEMI)患者30例；选取同期冠脉造影正常的非冠心病患者(NC)30例作为对照组。采用 ELISA法测定各组血浆 sCD40L和 Lp-PLA2水平,比较不同组间水平的差异；用冠脉 Gensini 积分评价 NSTE-ACS患者冠脉病变严重程度,分析 sCD40L、Lp-PLA2水平与冠脉 Gensini 积分的相关性；同时对 NSTE-ACS 患者入院时行 GRACE危险评分,分析 sCD40L、Lp-PLA2水平与 GRACE危险评分的相关性。结果①NSTEMI、UAP 组 sCD40L 水平高于 SAP和 NC组(P<0.05),NSTEMI和 UAP两组间差异无统计学意义(P>0.05),SAP 和 NC 两组间差异无统计学意义(P>0.05)；NSTEMI组 Lp-PLA2水平高于 UAP、SAP和 NC组(P<0.05),UAP组 Lp-PLA2水平高于 SAP和 NC组(P<0.05),差异有统计学意义(P<0.05)。②冠心病患者血浆 sCD40L水平与 Lp-PLA2水平明显相关(r=0.284,P<0.01),sCD40L 水平和 Gensini 积分、GRACE 危险评分明显相关(r=0.213,P<0.05；r=0.224,P<0.05)；Lp-PLA2水平与冠脉 Gensini积分、GRACE 危险评分明显相关(r=0.270,P<0.05；r=0.323,P<0.01)。③Logistic回归分析结果显示血浆 Lp-PLA2水平是 NSTE-ACS独立相关因素(P<0.05)。结论 NSTE-ACS患者血浆 sCD40L和Lp-PLA2水平明显增高,与冠脉病变严重程度相关,并提示冠状动脉粥样硬化斑块的不稳定性,可作为冠心病患者危险评估的预测指标。

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