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
The clinical significance of sCD40L and Lp-PLA2 in the assessment of coronary artery severity and risk classification in patients with non-ST-segment elevation acute coronary syndrome

摘要：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。
ABSTRACT: 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 96 patients with coronary heart disease diagnosed by coronary angiography, 28 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<0.05), but there was no significant difference between NSTEMI and UAP groups (P>0.05) or SAP and NC groups (P>0.05). 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