脂蛋白相关磷脂酶A2与颈动脉粥样硬化病变程度的相关性研究

摘要: 目的探索脂蛋白相关磷脂酶A2(lipoprotein phospholipase A2, Lp-PLA2)与颈动脉粥样硬化病变程度的相关性及临床意义。方法选取2019年10月—2020年4月安徽省立医院收住行Lp-PLA2检测和颈动脉评估的227例患者，按照颈动脉粥样硬化程度分为3组，无明显颈动脉狭窄为对照组(58例)，颈动脉狭窄＜50%为颈动脉粥样硬化组(119例)，颈动脉狭窄≥50%为颈动脉狭窄组(50例)；按照有无新发心血管事件分为无新发事件组(154例)和新发事件组(73例)。检测Lp-PLA2及其他常规入院检验，分析各指标与颈动脉粥样硬化程度的关系，采用多元线性回归模型分析颈动脉粥样硬化病变的相关因素。结果与对照组Lp-PLA2[(89.29±41.15)ng/mL]相比，颈动脉粥样硬化组[(103.92±37.90)ng/mL]与颈动脉狭窄组[(121.96±41.27)ng/mL]Lp-PLA2明显升高(均P＜0.05)；新发事件组Lp-PLA2[(114.93±36.50)ng/mL]显著高于无新发事件组[(98.76±42.47)ng/mL，P＜0.05]。多元线性回归分析结果表明，Lp-PLA2是颈动脉粥样硬化的独立影响因素。结论 Lp-PLA2与颈动脉粥样硬化病变程度具有相关性，且随着颈动脉粥样硬化程度的加深，血清Lp-PLA2浓度同步升高。
- 脂蛋白磷脂酶A2 /
- 颈动脉评估 /
- 颈动脉粥样硬化程度 /
- 心血管缺血事件
Abstract: Objective To investigate the correlation and clinical significance of lipoprotein phospholipase A2 (Lp-PLA2) with the extent of atherosclerosis in carotid arteries. Methods A total of 227 patients admitted at Anhui Provincial Hospital from October 2019 to April 2020 were included in this study. Patients were divided into three groups according to the degree of carotid artery atherosclerosis, namely, control group (no significant carotid stenosis, n=58), carotid atherosclerosis group (carotid artery stenosis < 50%, n=119) and carotid stenosis group (carotid stenosis≥50%, n=50). According to whether there are new cardiovascular events, they were divided into no new event group (154 cases) and new event group (73 cases). The levels of Lp-PLA2 and other conventional indicators were detected in all subjects, and the relationship between their levels and degree of carotid atherosclerosis was analysed, and analyzing the factors associated with carotid atherosclerotic lesions using multiple linear regression models. Results Compared with the control group [(89.29±41.15) ng/mL], Lp-PLA2 was significantly increased in the carotid atherosclerosis group [(103.92±37.90) ng/mL] and carotid stenosis group [(121.96±41.27) ng/mL, all P < 0.05]. Lp-PLA2 in the new event group [(114.93±36.50) ng/mL] was significantly higher than that in the no new event group [(98.76±42.47) ng/mL, P < 0.05]. Linear regression analysis showed that Lp-PLA2 was an independent risk factor for carotid atherosclerosis. Conclusion Lp-PLA2 was correlated with the degree of carotid atherosclerosis. The serum Lp-PLA2 concentration increased with the gradual deepening of carotid atherosclerosis.
- Lipoprotein-associated phospholipase A2 /
- Carotid artery assessment /
- Degree of carotid atherosclerosis /
- Cardiovascular ischemic events

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表 1 不同颈动脉粥样硬化程度患者组间各指标比较

组别	例数	性别[例(%)]		年龄(x ±s，岁)	Lp-PLA2 (x ±s，ng/mL)	TC(x ±s，mmol/L)	TG[M(P₂₅, P₇₅)，mmol/L]	HDL-C (x ±s，mmol/L)
组别	例数	男性	女性	年龄(x ±s，岁)	Lp-PLA2 (x ±s，ng/mL)	TC(x ±s，mmol/L)	TG[M(P₂₅, P₇₅)，mmol/L]	HDL-C (x ±s，mmol/L)
对照组	58	35(60.34)	23(39.66)	57.02±9.12	89.29±41.15	3.81±0.87	1.10(0.88, 1.74)	1.00±0.22
颈动脉粥样硬化组	119	79(66.39)	40(33.61)	59.58±9.95	103.92±37.90^c	4.01±1.25	1.36(1.06, 1.98)	0.94±0.25
颈动脉狭窄组	50	32(64.00)	18(36.00)	61.32±7.76	121.96±41.27^cd	4.25±0.92	1.30(0.91, 1.80)	0.96±0.21
统计量		0.752^a		2.115^b	8.483^b	1.554^b	5.190^e	0.726^b
P值		0.687		0.124	< 0.001	0.215	0.075	0.486

组别	例数	LDL-C (x ±s, mmol/L)	VLDL-C (x ±s, mmol/L)	ApoA1 (x ±s, g/L)	ApoB (x ±s, g/L)	Lpa [M(P₂₅, P₇₅)，mg/L]		斑块计数[M(P₂₅, P₇₅)]
对照组	58	2.06±0.71	0.76±0.35	1.24±0.23	0.81±0.21	162.50(79.75, 369.00)		0(0, 0)
颈动脉粥样硬化组	119	2.24±0.97	0.82±0.28	1.20±0.25	0.90±0.33	225.00(115.00, 368.00)		2(1, 3)^c
颈动脉狭窄组	50	2.41±0.69	0.87±0.18	1.22±0.26	0.97±0.25^c	344.50(147.50, 670.00)^cd		3(2, 4)^cd
统计量		1.702^b	1.631^b	0.266^b	3.080^b	8.763^e		146.897^e
P值		0.486	0.199	0.767	0.049	0.013		< 0.001
注：^a为χ²值，^b为F值，^e为H值。与对照组比较，^cP＜0.05；与颈动脉粥样硬化组比较，^dP＜0.05。

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表 2 新发事件组与无新发事件组患者各指标比较

组别	例数	性别[例(%)]		年龄(x ±s, 岁)	Lp-PLA2 [M(P₂₅, P₇₅), ng/mL]	TC(x ±s, mmol/L)	TG[M(P₂₅, P₇₅), mmol/L]	HDL-C (x ±s, mmol/L)
组别	例数	男性	女性	年龄(x ±s, 岁)	Lp-PLA2 [M(P₂₅, P₇₅), ng/mL]	TC(x ±s, mmol/L)	TG[M(P₂₅, P₇₅), mmol/L]	HDL-C (x ±s, mmol/L)
无新发事件组	154	103(66.88)	51(33.12)	61.67±8.63	102.00(77.00, 130.50)	3.90±1.02	1.37(0.97, 1.93)	0.99±0.24
新发事件组	73	43(58.90)	30(41.10)	61.41±9.29	111.00(97.00, 139.00)	4.21±1.12	1.41(1.00, 2.18)	0.96±0.26
统计量		1.374^a		0.303^b	-4.622^c	-2.267^b	-1.651^c	0.777^b
P值		0.241		0.762	< 0.001	0.024	0.099	0.438

组别	例数	LDL-C (x ±s, mmol/L)	VLDL-C (x ±s, mmol/L)	ApoA1 (x ±s, g/L)	ApoB (x ±s, g/L)	Lpa [M(P₂₅, P₇₅), mg/L]		斑块计数[M(P₂₅, P₇₅)]
无新发事件组	154	2.11±0.81	0.79±0.24	1.30±0.29	0.85±0.27	180.00(101.00, 347.50)		2.00(0.00, 3.00)
新发事件组	73	2.40±0.83	0.85±0.40	1.27±0.33	0.94±0.28	216.50(101.00, 357.00)		2.00(0.75, 3.00)
统计量		-2.565^b	-1.252^b	0.540^b	-2.448^b	-1.301^c		-0.160^c
P值		0.011	0.214	0.590	0.015	0.193		0.873
注：^a为χ²值，^b为t值，^c为U值。

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表 3 颈动脉粥样硬化病变程度的线性回归分析

项目	B	SE	B'	t值	P值
常数	-0.015	0.318		-0.046	0.964
年龄(岁)	-0.001	0.004	-0.017	-0.304	0.761
Lp-PLA2(ng/mL)	0.003	0.001	0.191	2.824	0.005
TC(mmol/L)	0.233	0.992	0.346	0.235	0.815
TG(mmol/L)	-0.093	0.049	-0.144	-1.910	0.058
HDL-C(mmol/L)	-0.610	1.012	-0.197	-0.603	0.548
LDL-C(mmol/L)	-0.293	0.982	-0.340	-0.298	0.766
VLDL-C(mmol/L)	0.153	1.014	0.060	0.151	0.881
ApoA1(g/L)	0.199	0.229	0.067	0.868	0.387
ApoB(g/L)	0.156	0.341	0.061	0.459	0.647
Lpa(mg/L)	0.000	0.000	-0.034	-0.616	0.539
斑块计数	0.359	0.027	0.729	13.315	< 0.001

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表 4 回归方程方差分析表

变异来源	平方和	自由度	均方	F值	P值
回归	50.121	11	4.556	24.355	< 0.001
残差	24.508	215	0.187
总和	74.629	226

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