【摘要】：目的:旨在分析脂蛋白相關(guān)磷脂酶A2(Lp-PLA2)、趨化因子配體16(CXCL16)、中性粒細(xì)胞計(jì)數(shù)及中性粒細(xì)胞數(shù)與淋巴細(xì)胞數(shù)比值(NLR)與急性冠脈綜合征患者冠脈病變嚴(yán)重程度、易損斑塊的相關(guān)性。方法:1)研究對(duì)象及分組:選取2016年1月-2017年2月在遵義醫(yī)學(xué)院附屬醫(yī)院心內(nèi)科住院行CAG檢查診斷為冠心病患者224例,分為急性冠脈綜合征(ACS)組和穩(wěn)定型心絞痛(SAP)組,其中ACS組186例(UA 75例、NSTEMI 52例、STEMI 59例),SAP組38例。將ACS組中行OCT檢查患者據(jù)OCT結(jié)果分為易損斑塊(VP)組和穩(wěn)定型斑塊(SP)組,其中VP組9例,SP組8例;ACS組據(jù)Gensini評(píng)分結(jié)果分為低水平組57例,中等水平組70例,高水平組59例。2)檢測(cè)血清中Lp-PLA2、CXCL16水平,所有患者均在CAG檢查前經(jīng)介入途徑采集動(dòng)脈血。將處理好的血清貯藏于-80℃低溫冰箱保存,統(tǒng)一采用酶連免疫吸附測(cè)定法(ELISA)測(cè)定其濃度。由遵義醫(yī)學(xué)院檢驗(yàn)科協(xié)助分析血清中性粒細(xì)胞計(jì)數(shù)、NLR水平。結(jié)果:1)通過比較SAP組、UA組、NSTEMI組及STEMI組間一般資料及血生化指標(biāo)發(fā)現(xiàn):高血壓、糖尿病、吸煙在四組間存在統(tǒng)計(jì)學(xué)差異(P㩳0.05),TC、LDL、Lp-PLA2、CXCL16、中性粒細(xì)胞計(jì)數(shù)及NLR水平在SAP組、UA組、NSTEMI組及STEMI組中依次呈遞增趨勢(shì),且差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05),而在年齡、性別、飲酒方面,四組間比較差異無統(tǒng)計(jì)學(xué)意義(P㧐0.05)。2)與SAP組相比,ACS組患者中合并高血壓、吸煙、Lp-PLA2、CXCL16、中性粒細(xì)胞計(jì)數(shù)及NLR水平均升高,且差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05)。而在年齡、性別、糖尿病、飲酒、TC、LDL方面未見明顯差異(P㧐0.05)。通過回歸分析結(jié)果顯示:高血壓、Lp-PLA2是ACS的危險(xiǎn)因素。3)與穩(wěn)定型斑塊組相比,易損斑塊組患者中高血壓、吸煙率、LDL、Lp-PLA2、CXCL16、中性粒細(xì)胞計(jì)數(shù)及NLR水平均升高,且差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05),而在年齡、性別、合并糖尿病、TC、HDL方面未見明顯差異(P㧐0.05)。4)據(jù)不同Gensini積分水平分析發(fā)現(xiàn):年齡、性別、高血壓、吸煙、TC、Lp-PLA2、CXCL16、中性粒細(xì)胞計(jì)數(shù)及NLR在不同Gensini積分組間可見統(tǒng)計(jì)學(xué)差異(P㩳0.05),而在合并糖尿病、飲酒、LDL、HDL方面未見明顯差異。Lp-PLA2、CXCL16、中性粒細(xì)胞計(jì)數(shù)及NLR均與高Gensini積分呈正相關(guān)。Lp-PLA2、中性粒細(xì)胞計(jì)數(shù)及NLR對(duì)高Gensini積分的預(yù)測(cè)上均有良好的曲線下面積,而CXCL16的曲線下面積欠佳。結(jié)論:本研究結(jié)果表明:1.合并高血壓、Lp-PLA2是ACS危險(xiǎn)因素,Lp-PLA2與斑塊的易損性密切相關(guān);2.CXCL16、NLR與ACS、斑塊易損性相關(guān);3.Lp-PLA2、中性粒細(xì)胞計(jì)數(shù)及NLR對(duì)ACS冠脈嚴(yán)重病變均有一定預(yù)測(cè)價(jià)值;4.Lp-PLA2對(duì)ACS冠脈嚴(yán)重病變預(yù)測(cè)性最佳,當(dāng)大于5.95后預(yù)測(cè)高水平GS患者特異度、敏感度最佳。
[Abstract]:Objective: to analyze the relationship between lipoprotein associated phospholipase A2 (Lp-PLA2), chemokine ligand 16 (CXCL16), neutrophil count, neutrophil / lymphocyte ratio (NLR) and severity of coronary artery disease in patients with acute coronary syndrome (ACS). Correlation of vulnerable plaques. Methods: 1) study subjects and groups: 224 patients with coronary heart disease diagnosed by CAG examination were selected from January 2016 to February 2017 in the Department of Cardiology, affiliated Hospital of Zunyi Medical College. The patients were divided into acute coronary syndrome (ACS) group and stable angina pectoris (SAP) group. There were 186 cases of ACS group (UA 75 cases, NSTEMI 52 cases, STEMI 59 cases), SAP 38 cases). According to the results of OCT, patients with OCT in ACS group were divided into vulnerable plaque (VP) group and stable plaque (SP) group, including VP group (9 cases) and SP group (8 cases). ACS group was divided into low level group (57 cases), moderate group (70 cases) and high level group (59 cases) according to Gensini score. The treated serum was stored in -80 鈩，

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