Correlation Between Inflammatory Factors And Vulnerable Plaque In Coronary Arteries And Discussion Of Early Predictive Value Of ACS

Objective : Through the levels of serum inflammatory factors(lipoprotein-associated phospholipase A2(Lp-PLA2),myeloperoxidase(MPO)and high sensitive C reactive protein(hs-CRP)),coronary angiography(CAG)and intravascular ultrasound(IVUS),to investigate the correlation between inflammatory factors and coronary vulnerable plaque,and explore the early predictive value of it in acute coronary syndrome(ACS).Method:(1)Subgroups: 247 patients with the suspicion of coronary artery disease(CAD),who were enrolled in the Department of Cardiology of the First Affiliated Hospital of Hebei North University from October 2018 to August 2019,were consecutively selected.CAG was completed within 24 hours after admission.According to symptoms,signs and the results of CAG,they were divided into acute myocardial infarction(AMI)group(n=87),unstable angina pectoris(UAP)group(n=85),stable angina pectoris(SAP)group(n=28)and control group(n=47).According to Ambrose,they were divided into the simple lesion group(n=69)and the complex lesion group(n=131).Patients with CAD and agreeing to receive IVUS,according to the results of IVUS,were divided into vulnerable plaque group(n=23)and non-vulnerable plaque group(n=20).(2)Data Collection:(1)General clinical data: gender,age,history of diabetes,history of hypertension,family history of coronary artery disease,smoking history,etc;(2)Laboratory data: blood routine indicators(such as white blood cell count(WBC),red blood cell count(RBC),platelet count(PLT),etc.),blood biochemical indicators(such as liver function,kidney function,total cholesterol(TC),low density lipoprotein-cholesterol(LDLC),fasting blood glucose(FBG),triglycerides(TG),uric acid(UA),total bilirubin(TB),hs-CRP,etc.).(3)Specimen collection and processing: All selected patients were collected venous blood 5ml with heparin anticoagulation biochemical tube immediately after admission.The venous blood was centrifuged at 3200 r / min for 15 min at room temperature.The supernatant was stored in a-80 ℃ ultra-low temperature refrigerator.Enzyme linked immunosorbent assays(ELISA)was used to determine the levels of serum Lp-PLA2 and MPO.(4)Statistical analysis: All data were statistically analyzed with SPSS 22.0 software.The levels of serum inflammatory factors between the two groups were analyzed with the Mann–Whitney U test,and three or more groups with the Kruskal–Wallis H test,P <0.05 indicated that the difference was statistically significant.The ROC curve was drawn to analyze the different inflammatory factors’ value for predicting ACS.Result:(1)There was no significant difference in age,sex,smoking,diabetes,hypertension,TB,UA,TG,TC,and LDL-C among the four groups(P> 0.05),while there was significant difference in hs-CRP and WBC(P <0.05).(2)Lp-PLA2 level: The level of serum Lp-PLA2 in group of AMI,UAP,and SAP was significantly higher than that in the control group(P <0.01).The level of serum Lp-PLA2 in group of AMI and UAP was significantly higher than that in the SAP group(P <0.01).The level of serum Lp-PLA2 in group of UAP was significantly higher than that in the SAP group(P <0.01).MPO level: The level of serum MPO in group of AMI and UAP was significantly higher than that in the SAP group and the control group(P <0.01).The level of serum MPO in group of AMI was significantly higher than that in the UAP group(P <0.01).There was no significant difference in the levels of serum MPO between SAP group and control group(P >0.05).(3)The levels of serum Lp-PLA2 and MPO were positively correlated with Gensini scores(r = 0.702,0.567,P <0.001).(4)The levels of serum Lp-PLA2,MPO,and hs-CRP in the complex lesion group were higher than those in the simple lesion group,and the differences were statistically significant(P <0.01).(5)The levels of serum Lp-PLA2,MPO and hs-CRP in the vulnerable plaque group were higher than those in the non-vulnerable plaque group,and the differences were statistically significant(P <0.01).(6)ROC curve of predicting ACS: When Lp-PLA2 cut-off value was 207.6 ng/m L,the area under the curve(AUC)was 0.872(95%CI=0.826～0.918,P<0.001),the sensitivity was 81.4%,and the specificity was 81.1%.When MPO cut-off value was 64.9 ng/m L,the area under the curve was 0.777(95%CI=0.764～0.887,P<0.001),the sensitivity was 77.9%,and the specificity was 69.3%.When hs-CRP cut-off value was 0.45 mg/L,the area under the curve was 0.639(95%CI=0.565～0.713,P<0.001),the sensitivity was 50.0%,and the specificity was 73.3%;Conclusions:1.The levels of serum Lp-PLA2,MPO and hs-CRP are related to the clinical type of CAD.2.The levels of serum Lp-PLA2,MPO are positively correlated with Gensini scores,both of which can reflect the severity of coronary atherosclerotic lesions.3.The levels of serum Lp-PLA2,MPO and hs-CRP are significantly increased in the complex lesion group and the vulnerable plaque group.It can be used as a marker for predicting plaque stability.4.The levels of serum Lp-PLA2,MPO and hs-CRP are of value to ACS’ prediction.The diagnostic value of serum Lp-PLA2 is more significant in the diagnosis of ACS than serum MPO and hs-CRP.