脂蛋白相关磷脂酶A2联合抗凝血酶Ⅲ在非ST段抬高型急性冠脉综合征患者中的预测风险价值

摘要

目的观察非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者血浆脂蛋白相关磷脂酶A2(Lp-PLA2)、抗凝血酶Ⅲ(AT-Ⅲ)的水平变化及其预测风险价值.方法选取2016年2月～2017年2月于徐州医科大学附属医院心内三科行冠状动脉(冠脉)造影的住院患者249例,根据造影结果分为NSTE-ACS组(183例)和对照组(66例),比较两组Lp-PLA2和AT-Ⅲ的差异,采用GRACE评分系统进行评分及分层,同时利用Gensini积分系统评定冠状动脉狭窄程度.结果NSTE-ACS组Lp-PLA2水平高于对照组(P＜0.05),AT-Ⅲ水平低于对照组(P＜0.05);随着积分的增加,Lp-PLA2、AT-Ⅲ分别呈升高和下降趋势(P＜0.05);在GRACE评分危险度分组中,Lp-PLA2水平在各个亚组间依次升高(P均＜0.05),与低危组和中危组相比,高危组AT-Ⅲ活性降低,Gensini积分升高(P均＜0.05);Logistic回归分析表明:Lp-PLA2、GRACE评分是NSTE-ACS独立的危险因素,AT-Ⅲ是NSTE-ACS的保护性因素;相关性分析显示:Lp-PLA2与Gensini积分、GRACE评分均呈明显正相关,AT-Ⅲ与Gensini积分、GRACE评分均呈明显负相关;结论Lp-PLA2及AT-Ⅲ水平对NSTE-ACS患者在风险评估方面有一定的预测价值.%Objective To investigate the change and risk prediction value of lipoprotein-associated phospholipase A2(Lp-PLA2) and antithrombinⅢ (AT-Ⅲ) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), and the combination of Global Registry of Acute Coronary Events (GRACE) score to observe the value of coronary heart disease risk stratification.Methods A total of 249 patients admitted in our hospital were enrolled.The patients were divided into two groups:NSTE-ACS group (183 cases) and Control group (66 cases).The differences between the two groups of Lp-PLA2 and AT-Ⅲwere compared, and the GRACE scoring system was used for scoring and stratification.The Gensini score system was used to assess the degree of coronary artery stenosis.Results Lp-PLA2 level in the NSTE-ACS group was significantly higher than that in the Control group (P＜0.05), but AT-Ⅲlevel was lower than that in the Control group (P＜0.05).In the groups of different Gensini score, the level of Lp-PLA2 increased in each subgroup (P＜0.05).Compared with the low-risk subgroup and the middle-risk subgroup, the AT-III activity was lower and the Gensini score was higher in the highrisk subgroup (P＜0.05).Logistic regression analysis showed that Lp-PLA2 and GRACE scores were independent risk factors for NSTE-ACS, and AT-Ⅲwas a protective factor for NSTE-ACS.Correlation analysis showed that Lp-PLA2 was positively correlated with Gensini score and GRACE score, and AT-Ⅲwas significantly negatively correlated with Gensini score and GRACE score.Conclusion The level of Lp-PLA2 and AT-Ⅲhave certain risk predictive value in NSTE-ACS patients.