【摘要】 目的:探讨急性冠脉综合征(ACS)患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)与全球急性冠状动脉事件注册(GRACE)评分的相关性,分析其对ACS患者住院期间发生主要不良心脏事件(MACE)的预测价值。方法:选取ACS患者257例,采用GRACE评分软件对患者进行风险评估并进行危险分层。所有入选患者住院期间进行ACS的常规治疗,观察MACE发生的情况。患者入院后24 h内采用免疫比浊法测定血清Lp-PLA2水平,并评价血清Lp-PLA2水平与GRACE评分及危险分层的关系。使用受试者工作曲线分析基线Lp-PLA2水平及GRACE评分对ACS患者住院期间发生MACE的曲线下面积,评估其预测价值。结果:ACS患者GRACE评分危险分层高危组(>140分)Lp-PLA2水平显著高于中危组(109~140分)和低危组(≤108分)(P<0.05);中危组ACS患者Lp-PLA2水平高于低危组(P<0.05);将Lp-PLA2水平从低到高按四分位数分成Q1-Q4组,Q4组GRACE评分高于Q4以下组(P<0.05)。进行双变量相关分析表明Lp-PLA2水平与GRACE评分呈正相关(r=0.737,P<0.001),受试者工作曲线基线Lp-PLA2水平及GRACE评分对ACS患者住院期间发生MACE的曲线下工作面积分别为0.771及0.785,两者比较差别无统计学意义。结论:ACS患者血清Lp-PLA2水平与GRACE评分呈正相关,Lp-PLA2对ACS患者进行早期危险度分层方面有一定价值;Lp-PLA2和GRACE评分均对ACS患者住院期间发生MACE的预测有较好价值。更多还原

【Abstract】 Objective:To determine the correlation between lipoprotein-associated phospholipase A2(Lp-PLA2) levels and global registry of acute coronary events(GRACE)risk score as well as risk stratification in patients with acute coronary syndrome(ACS),and to explore the clinical prognostic effect of Lp-PLA2 for major adverse cardiac events(MACE)in ACS patients.Methods:A total of 257 ACS patients were subjected to risk assessment and stratification with GRACE risk score.All ACS patients received conventional treatments and MACE was recorded.Plasma Lp-PLA2 was measured by enzyme-linked immunosorbent assay and the relationship between plasma LpPLA2 level and GRACE scores in ACS patients was analyzed.Prediction accuracy of Lp-PLA2 level and GRACE risk score for MACE were determined by receiver operating characteristic curve and the corresponding area under the curve.Results:According to GRACE risk stratification,Lp-PLA2 level was significantly elevated in the high risk group(>140)compared with that in the middle risk group(109-140,P<0.05),while Lp-PLA2 level was significantly elevated in the middle risk group compared with that in the low risk group(≤108,P<0.05).According to the Lp-PLA2 level,patients were stratified into 4 groups by quartile(from the lowest to the highest,Q1-Q4).Compared with Q1-Q3 groups,the GRACE risk score and percentage of high risk patients were the highest in the Q4 group(P<0.05).Receiver operating characteristic curve analysis showed that Lp-PLA2 level was positively correlated with GRACE risk score and that the area under the curve of Lp-PLA2 level and GRACE risk score for predicting MACE during hospitalization were 0.771 and 0.785,respectively.Conclusion:Plasma Lp-PLA2 level is positively correlated with GRACE risk score.Both Lp-PLA2 level and GRACE risk score are valuable parameters to identify MACE in patients with ACS.Lp-PLA2 might be an important biomarker in the prognosis for ACS patients.更多还原