Value of carotid artery color Doppler ultrasound with or without plaque formation combined with Lp-PLA2 level in screening and predicting the progression of coronary heart disease in high-risk population
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摘要:
目的探讨颈动脉彩超联合血清脂蛋白相关磷脂酶A2（Lp-PLA2）在冠心病高危人群中的应用价值。 方法选取2018年1月~2021年1月在我院就诊的冠心病高危人群300例，分析冠心病和非冠心病患者颈动脉中膜厚度、斑块及血清Lp-PLA2差异，采用受试者工作特征曲线（ROC）分析颈动脉中膜厚度、斑块及血清Lp-PLA2预测冠心病、多支病变的价值。 结果经冠脉造影检查确诊冠心病患者73例，冠心病发生率为24.33%；冠心病患者颈动脉中膜厚度、颈动脉斑块比例、血清Lp-PLA2高于非冠心病患者（P < 0.05）；冠心病多支病变患者颈动脉中膜厚度、颈动脉斑块比例、血清Lp-PLA2分高于单支病变患者（P < 0.05）；颈动脉中膜厚度、斑块、Lp-PLA2联合预测冠心病的ROC曲线下面积为0.821（P < 0.05），诊断敏感度和特异性分别为80.00%和78.50%；颈动脉中膜厚度、斑块、Lp-PLA2联合预测冠心病多支病变的ROC曲线下面积为0.894（P < 0.05），诊断敏感度和特异性分别为92.00%和82.50%。 结论颈动脉彩超联合血清Lp-PLA2在冠心病高危人群筛查中有较好的应用价值，在诊断冠心病及多支病变中价值较高。 -
关键词:
- 颈动脉彩超 /
- 脂蛋白相关磷脂酶A2 /
- 冠心病 /
- 高危人群 /
- 诊断价值
Abstract:ObjectiveTo investigate the application value of carotid artery color Doppler ultrasound combined with serum lipoprotein associated phospholipase A2 (Lp-PLA2) in high-risk population of coronary heart disease. MethodsA total of 300 patients with high risk of coronary heart disease in our hospital from January 2018 to January 2021 were selected. The differences of carotid artery media thickness, plaque and serum Lp-PLA2 between coronary heart disease and non coronary heart disease patients were analyzed. The receiver operating characteristic curve (ROC) was used to analyze the value of carotid artery intima-media thickness, plaque and serum Lp-PLA2 in predicting coronary heart disease and multivessel disease. ResultsThere were 73 patients with coronary heart disease diagnosed by coronary angiography, and the incidence of coronary heart disease was 24.33%. The carotid media thickness, carotid plaque ratio and serum Lp-PLA2 in coronary heart disease patients were significantly higher than that in patients without coronary heart disease (P < 0.05). In patients with multi vessel coronary artery disease, carotid artery intima-media thickness, carotid artery plaque ratio and serum Lp-PLA2 were significantly higher than that in patients with single vessel disease (P < 0.05). The area under the ROC curve of carotid media thickness, plaque and Lp-PLA2 joint in predicting coronary heart disease was 0.821 (P < 0.05), the sensitivity and specificity were 80.00% and 78.50% respectively. The area under the ROC curve of carotid intima-media thickness, plaque and Lp-PLA2 joint in predicting multi vessel lesions of coronary heart disease was 0.894 (P < 0.05), the diagnostic sensitivity and specificity were 92.00% and 82.50% respectively. ConclusionCarotid artery color Doppler ultrasound combined with serum Lp-PLA2 has good application value in the screening of high-risk population of coronary heart disease.It has high value in the diagnosis of coronary heart disease and multi vessel disease. -
图 1 颈动脉彩超、血清Lp-PLA2预测冠心病的ROC曲线图
Figure 1. ROC curves of carotid artery ultrasound and serum Lp-PLA2 in predicting coronary heart disease
图 2 颈动脉彩超、血清Lp-PLA2预测冠心病多支病变的ROC曲线图
Figure 2. ROC curves of carotid artery ultrasound and serum Lp-PLA2 in predicting multi-vessel coronary heart disease.
表 1 冠心病和非冠心病患者临床资料比较
Table 1. Comparison of clinical data between CHD and non-CHD patients
临床资料 冠心病(n=73) 非冠心病(n=227) t/χ2 P 性别[n(%)] 0.625 0.429 男 45(61.64) 128(56.39) 女 28(38.36) 99(43.61) 年龄(岁, Mean±SD) 61.12±8.94 58.89±9.11 1.827 0.069 文化程度[n(%)] 0.542 0.462 高中以下 46(63.01) 132(58.15) 高中及以上 27(36.99) 95(41.85) 收缩压(mmHg, Mean±SD) 132.26±12.36 133.70±14.41 -0.768 0.443 舒张压(mmHg, Mean±SD) 81.15±9.96 82.25±10.27 -0.802 0.423 
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表 2 冠心病和非冠心病患者颈动脉彩超、血清Lp-PLA2比较
Table 2. Comparison of carotid ultrasound and serum Lp-PLA2 in patients with and without CHD
组别 颈动脉中膜厚度(mm, Mean±SD) 颈动脉斑块(%) Lp-PLA2(ng/mL, Mean±SD) 冠心病(n=73) 1.10±0.18 55(75.34) 232.21±82.36 非冠心病(n=227) 0.85±0.20 112(49.34) 181.19±71.03 t/χ2 9.511 15.134 5.129 P 0.000 0.000 0.000
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表 3 冠心病单支和多支病变患者颈动脉彩超、血清Lp-PLA2比较
Table 3. Comparison of carotid ultrasound and serum Lp-PLA2 in patients with single-vessel and multi-vessel coronary heart disease
组别 颈动脉中膜厚度(mm, Mean±SD) 颈动脉斑块(%) Lp-PLA2(ng/mL, Mean±SD) 单支病变(n=30) 0.98±0.17 17(56.67) 201.18±52.32 多支病变(n=43) 1.18±0.21 38(88.37) 253.86±48.00 t/χ2 -4.319 9.562 -4.446 P 0.000 0.002 0.000
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[1] 刘向阳, 李爱华, 唐良秋. 脂蛋白相关磷脂酶A2与冠心病患者踝臂指数、心率变异性的相关性研究[J]. 实用心脑肺血管病杂志, 2020, 28 (3): 44-50. doi: 10.3969/j.issn.1008-5971.2020.03.010 [2] 李文松, 张润峰. 脂蛋白相关磷脂酶A2与冠心病的相关性研究进展[J]. 心血管病学进展, 2020, 41(1): 85-8. https://www.cnki.com.cn/Article/CJFDTOTAL-XXGB202001024.htm [3] 李凤, 陈静丹, 薛桂君. 老年冠心病合并高血压患者血清NO、Lp-PLA2、Hcy水平与颈动脉粥样硬化程度的关系[J]. 标记免疫分析与临床, 2019, 26(2): 185-8. https://www.cnki.com.cn/Article/CJFDTOTAL-BJMY201902002.htm [4] 孙鲲, 宋文超, 周文恒. 益气活血通脉法联合阿托伐他汀对高血压病颈动脉粥样硬化患者血清脂蛋白相关磷脂酶A2、趋化因子配体与氧化应激指标影响[J]. 辽宁中医药大学学报, 2020, 22(4): 166-9. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB202004042.htm [5] Ferrario MM, Veronesi G, Roncaioli M, et al. Exploring the interplay between job strain and different domains of physical activity on the incidence of coronary heart disease in adult men[J]. Eur J Prev Cardiol, 2019, 26(17): 1877-85. doi: 10.1177/2047487319852186 [6] Timalsena BK, Malla R, Maskey A, et al. Comparison of extent and severity of coronary artery disease in patients with and without diabetes mellitus presenting with non ST-segment elevation myocardial infarction[J]. Nepal Heart J, 2020, 17(2): 7-11. doi: 10.3126/njh.v17i2.32672 [7] Vasu DP, Kulkarni AG, Gangadhar NK. Prevalence of Risk factors for Coronary heart disease among the workers of an industry of South India[J]. Indian J Community Heal, 2020, 32(4): 637-42. doi: 10.47203/IJCH.2020.v32i04.005 [8] Mykhailovska NS, Kulynych TO, Grytsai HV, et al. The possibilities of prediction the coronary heart disease course after community acquired pneumonia[J]. Wiad Lek, 2019, 72(10): 1917-23. http://www.researchgate.net/publication/338841421_The_possibilities_of_prediction_the_coronary_heart_disease_course_after_community_acquired_pneumonia [9] Mavritsakis N, Cotoi BV, Ganescu A, et al. Clinical and biochemical correlations obesity - HDL cholesterol- ischemic coronary heart disease[J]. Rev Chim, 2019, 70(5): 1765-8. doi: 10.37358/RC.19.5.7211 [10] Gangaraju R, Chen YJ, Hageman L, et al. Coronary heart disease risk in blood or marrow transplant survivors[J]. Blood, 2020, 136 (Supplement 1): 17-8. http://www.researchgate.net/publication/349092250_Coronary_Heart_Disease_Risk_in_Blood_or_Marrow_Transplant_Survivors [11] 李振洲, 邵玉凤, 陈胜华, 等. 颈动脉斑块稳定性超声评估与血浆脂蛋白相关磷脂酶A2水平的相关性研究[J]. 中国临床医学影像杂志, 2019, 30(3): 166-8, 173. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX201903007.htm [12] 刘向阳, 唐良秋, 范文茂, 等. 不同血压昼夜节律冠心病患者血浆同型半胱氨酸、血清脂蛋白相关磷脂酶A2水平变化及其与冠状动脉狭窄程度的关系研究[J]. 实用心脑肺血管病杂志, 2019, 27(1): 30-5. doi: 10.3969/j.issn.1008-5971.2019.01.007 [13] Espírito Santo C, Galindo Y, Almeida V, et al. High risk of bleeding in elderly patient with coronary artery disease[J]. J Transcat Intervent, 2020, 28: 1-6. http://www.researchgate.net/publication/341121412_Journal_of_Transcatheter_Interventions_-_High_risk_of_bleeding_in_elderly_patient_with_coronary_artery_disease_Alto_risco_de_sangramento_em_paciente_coronariopata_idoso/download [14] Borges MC, Schmidt AF, Jefferis B, et al. Circulating fatty acids and risk of coronary heart disease and stroke: individual participant data meta-analysis in up to 16 126 participants[J]. J Am Heart Assoc, 2020, 9(5): e013131. http://www.researchgate.net/publication/339659738_Circulating_Fatty_Acids_and_Risk_of_Coronary_Heart_Disease_and_Stroke_Individual_Participant_Data_Meta-Analysis_in_Up_to_16_126_Participants [15] Joshi R, Wannamethee SG, Engmann J, et al. Triglyceride-containing lipoprotein sub-fractions and risk of coronary heart disease and stroke: a prospective analysis in 11, 560 adults[J]. Eur J Prev Cardiol, 2020, 27(15): 1617-26. doi: 10.1177/2047487319899621 [16] Rämö JT, Ripatti P, Tabassum R, et al. Coronary artery disease riskand lipidomic profiles are similar in hyperlipidemias with family history and population-ascertained hyperlipidemias[J]. J Am Heart Assoc, 2019, 8(13): e012415. http://www.ncbi.nlm.nih.gov/pubmed/31256696 [17] Islam MS, Mondal SK, Jahan J, et al. Effect of PCI on QTC dispersion in patients with angina[J]. Univ Heart J, 2020, 16(1): 33-9. doi: 10.3329/uhj.v16i1.44820 [18] Weintraub WS. High-risk percutaneous coronary intervention in patients with stable ischemic heart disease[J]. Cardiovasc Revascularization Med, 2019, 20(4): 269-70. doi: 10.1016/j.carrev.2019.02.009 [19] Gurel NZ, Carek AM, Inan OT, et al. Comparison of autonomic stress reactivity in young healthy versus aging subjects with heart disease[J]. PLoS One, 2019, 14(5): e0216278. http://www.researchgate.net/publication/332951127_Comparison_of_autonomic_stress_reactivity_in_young_healthy_versus_aging_subjects_with_heart_disease [20] Mozayeni F, Rezaee SA, Jabbari Azad F, et al. High proviral load of human T cell lymphotropic virus type-1 facilitates coronary artery diseases[J]. Iran J Basic Med Sci, 2020, 23(4): 500-6. http://www.researchgate.net/publication/341911189_High_proviral_load_of_human_T_cell_lymphotropic_virus_type-1_facilitates_coronary_artery_diseases [21] 张伟, 张伊湄, 李琳琳, 等. 基于KIM分型脑白质病变患者血清脂蛋白相关磷脂酶A2变化及其与颈动脉粥样硬化斑块的相关性[J]. 中华医学杂志, 2020, 100(15): 1130-5. doi: 10.3760/cma.j.cn112137-20191125-02558 [22] 黄玲, 王佳楠, 徐芳, 等. 无症状性脑梗死颈动脉粥样硬化与脂蛋白相关磷脂酶A2的临床研究[J]. 中华老年心脑血管病杂志, 2020, 22 (11): 1132-5. https://www.cnki.com.cn/Article/CJFDTOTAL-LNXG202011005.htm [23] 刘东, 谢而付, 黄琳, 等. 急性缺血性脑卒中患者血浆脂蛋白相关磷脂酶A2的表达[J]. 江苏医药, 2019, 45(10): 986-8. https://www.cnki.com.cn/Article/CJFDTOTAL-YIYA201910004.htm -
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