血清生物标志物检测对急性冠脉综合征颈动脉斑块稳定性评价的意义

Significance of serum biomarkers detection for evaluating carotid plaque stability in acute coronary syndrome

摘要:

目的：检测急性冠脉综合征（acute coronary syndrome，ACS）患者相关血清生物标志物水平，探讨其对颈动脉斑块稳定性评价的临床意义。方法：选择2016年1月至2017年12月本院心血管内科收治的ACS患者90例，根据颈动脉超声检查结果将患者分为易损斑块组（51例）和稳定斑块组（39例），另选45例未见粥样硬化斑块者为对照组。ELISA法检测3组血清高敏C反应蛋白（high-sensitivity C reactive protein，hs-CRP）、正五聚蛋白-3（pentraxin-3，PTX-3）、妊娠相关性蛋白-A（pregnancy relat－ed protein-A，PAPP-A）、脂蛋白相关的磷脂酶A2（lipoprotein related phospholipase A2，Lp-PLA2）及氧化型低密度脂蛋白（oxi－dized low density lipoprotein，ox-LDL）水平。结果：观察组血清所有指标水平均明显高于正常对照组（P＜0.05）。易损斑块组血清PTX-3、PAPP-A、Lp-PLA2及ox-LDL水平明显高于稳定斑块组（P＜0.05）。Logistic回归分析结果显示，PTX-3、PAPP-A、Lp-PLA2及ox-LDL均是与斑块稳定性密切相关的影响因素（均P＜0.05），OR=1.2～2.0。ROC曲线分析结果显示，PTX-3、PAPP-A、Lp-PLA2及ox-LDL评价斑块稳定性的ROC曲线下面积分别为0.764、0.870、0.678及0.794；临界值分别为4.38 μg/L、11.28 U/L、181.64 μg/L及490.86 μg/L；灵敏度分别为62.7%、76.5%、51.0%及92.2%；特异性分别为92.3%、95.0%、84.6%及56.4%。结论：血清hs-CRP、PTX-3、PAPP-A、Lp-PLA2及ox-LDL水平升高关联于ACS颈动脉斑块不稳定，可作为评价ACS颈动脉斑块稳定性的血清学指标。

Abstract:

Objective：To detect the levels of serum biomarkers in acute coronary syndrome（ACS） patients and to explore the signifi－cance of the detection for evaluating carotid plaque stability. Methods：Totally 90 patients with ACS were selected from the car－diovascular department in our hospital during January 2016 and December 2017. The ACS patients were divided into the vulnerable plaque group（51 cases） and the stable plaque group（39 cases），according to the results of carotid ultrasonography. Forty-five healthy people，who without any carotid plaque were chosen as the control group. ELISA method was used to detect serum high-sensitivity C reactive protein（hs-CRP），pentraxin-3（PTX-3），pregnancy related protein-A（PAPP-A），lipoprotein related phospholipase A2（Lp-PLA2） and oxidized low density lipoprotein（ox-LDL） level in three groups. Results：The serum levels of all indicators in the observation group were significantly higher than those in the normal control group（P＜0.05）. The levels of serum PTX-3，PAPP-A，Lp-PLA2 and ox-LDL in vulnerable plaque group were significantly higher than those in stable plaque group（P＜0.05）. The OR value is be－tween 1.2 and 2. The results of ROC curve analysis showed that the area under the ROC curve（AUC） of PTX-3，PAPP-A，Lp-PLA2 and ox-LDL were 0.764，0.870，0.678 and 0.794，respec－tively，and the critical values were 4.38 μg/L，11.28 U/L，and 181.64 μg/L and 490.86 μg/L，respectively. The sensitivity was 62.7%，76.5%，51% and 92.2%，and the specificity was 92.3%，95%，84.6% and 56.4%，respectively. Conclusion：Elevated serum hs-CRP，PTX-3，PAPP-A，Lp-PLA2 and ox-LDL level is closely related to ACS carotid plaque instability. It can be used as a serolog－ical index to evaluate the stability of carotid plaques in ACS.