文章摘要

Lp-PLA2、MMP-9与心肌超声造影的相关性及其对急性冠脉综合征预后的评估价值

作者: 1孙美娜, 1李令娟, 1刘冬, 1王卫娟, 2王宏伟
1 廊坊市第四人民医院/承德医学院附属医院心血管内科，河北 廊坊 065700
2 廊坊市第四人民医院/承德医学院附属医院介入科，河北 廊坊 065700
通讯: 李令娟 Email: LLjxnk_982@163.com
DOI: 10.3978/j.issn.2095-6959.2022.07.008
基金: 廊坊市科学技术研究与发展计划(2020013102)。

摘要

目的：探讨脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2，Lp-PLA2)、基质金属蛋白酶9(matrix metalloproteinase 9，MMP9)与心肌超声造影的相关性及对急性冠脉综合征(acute coronary syndrome，ACS)预后的评估价值。方法：选取廊坊市第四人民医院收治的119例ACS患者，为ACS组；选取冠脉内径狭窄率<50%、排除冠心病的住院患者60例，为对照组。根据冠脉病变程度，分为轻度病变组、中度病变组、重度病变组；根据GRACE评分分为低危组、中危组、高危组；根据预后情况[主要心脏不良事件(major cardiac event，MACE)]分为MACE组与非MACE组。比较各组血清Lp-PLA2、MMP-9水平及心肌超声造影β值、A值。分析ACS发生的影响因素、Lp-PLA2、MMP-9与冠脉病变、危险分层及β值、A值的相关性；采用受试者工作特征(receiver operating characteristic，ROC)曲线分析Lp-PLA2、MMP-9预后的评估价值。结果：ACS组与对照组高密度脂蛋白胆固醇(high-density lipoprotein cholesterol，HDL-C)、C反应蛋白(C-reactive protein，CRP)、Lp-PLA2、MMP-9、β值、A值比较，差异有统计学意义(P<0.05)。Lp-PLA2、MMP-9升高、β值、A值降低为预测ACS发生的独立危险因素(P<0.05)。重度病变组Lp-PLA2、MMP-9水平高于轻度病变组、中度病变组(P<0.05)，β值、A值低于轻度病变组、中度病变组(P<0.05)；高危组Lp-PLA2、MMP-9水平高于低危组、中危组(P<0.05)，β值、A值低于低危组、中危组(P<0.05)。血清Lp-PLA2、MMP-9水平与冠脉病变、危险分层呈正相关(P<0.05)，与β值、A值呈负相关(P<0.05)。MACE组Lp-PLA2、MMP-9水平高于非MACE组(P<0.05)。Lp-PLA2与MMP-9预测MACE的AUC分别为0.716、0.680，二者联合预测MACE的AUC为0.891，高于单项指标预测MACE的AUC(Z=4.310，Z=5.654，P<0.05)。结论：血清Lp-PLA2、MMP-9是发生ACS的独立危险因素，与冠脉病变、危险分层及β值、A值相关，可用于ACS患者的病情评估和预后预测。
关键词： 急性冠脉综合征；脂蛋白相关磷脂酶A2；基质金属蛋白酶9；心肌超声造影；截断值

Correlation of Lp-PLA2 and MMP-9 with myocardial contrast echocardiography and prognostic value of acute coronary syndrome

Authors: 1SUN Meina, 1LI Lingjuan, 1LIU Dong, 1WANG Weijuan, 2WANG Hongwei
1 Department of Cardiovascular Medicine, Fourth People’s Hospital of Langfang City/Affiliated Hospital of Chengde Medical College, Langfang Hebei 065700, China
2 Department of Intervention, Fourth People’s Hospital of Langfang City/Affiliated Hospital of Chengde Medical College, Langfang Hebei 065700, China

CorrespondingAuthor: LI Lingjuan Email: LLjxnk_982@163.com

DOI: 10.3978/j.issn.2095-6959.2022.07.008

Foundation: This work was supported by the Science and Technology Research and Development Plan of Langfang City, China (2020013102).

Abstract

Objective: To investigate the correlation of lipoprotein-associated phospholipase A2 (Lp-PLA2) and matrix metalloproteinase-9 (MMP-9) with myocardial contrast echocardiography and prognostic value of acute coronary syndrome (ACS). Methods: A total of 119 ACS patients were selected and included in the ACS group, whereas 60 hospitalized patients with coronary artery stenosis rate <50% and coronary artery disease exclusion were included in the control group. According to the degree of coronary artery lesion, they were divided into a mild lesion group, a moderate lesion group and a severe lesion group. According to GRACE score, they were divided into a low-risk group, a medium-risk group, and a high-risk group. According to the prognosis, they were divided into an MACE group and a non-MACE group. The serum levels of Lp-PLA2 and MMP-9 and the β and A values of myocardial contrast-enhanced ultrasound were compared in each group. The influencing factors of ACS and the correlation between Lp-PLA2, MMP-9 and coronary artery disease, risk stratification, β and A value were analyzed. Receiver operating characteristic (ROC) curve was used to analyze the prognostic value of Lp-PLA2 and MMP-9. Results: There were statistically significant differences in HDL-C, CRP, Lp-PLA2, MMP-9, β and A values between ACS group and control group (P<0.05). The increase of Lp-PLA2 and MMP-9, the decrease of β and A values were the independent risk factors for predicting ACS (P<0.05). The levels of Lp-PLA2 and MMP-9 in severe lesion group were higher than those in mild and moderate lesion group (P<0.05), while the β and A values were lower than those in mild and moderate lesion group (P<0.05). The levels of Lp-PLA2 and MMP-9 in high-risk groups were higher than those in low-risk and medium-risk groups (P<0.05), while the β and A values were lower than those in low-risk and medium-risk groups (P<0.05). Serum Lp-PLA2 and MMP-9 levels were positively correlated with coronary artery disease and risk stratification (P<0.05), but negatively correlated with β and A values (P<0.05). The levels of Lp-PLA2 and MMP-9 in MACE group were higher than those in non-MACE group (P<0.05). The AUC predicted by Lp-PLA2 and MMP-9 was 0.716 and 0.680, respectively, while the AUC of MACE predicted by Lp-PLA2 binds to MMP-9 was 0.891, and higher than that predicted by single index (Z=4.310, Z=5.654, P<0.05). Conclusion: Serum Lp-PLA2 and MMP-9 are independent risk factors for ACS, which are correlated with coronary artery disease, risk stratification, β and A values, and can be used for disease evaluation and prognosis prediction of ACS patients.

Keywords： acute coronary syndrome; lipoprotein associated phospholipase A2; matrix metalloproteinase-9; myocardial contrast echocardiography; cut-off value

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