| Objective The levels of small and dense low-density lipoprotein cholesterol(sdLDL-C)and lipoprotein associated phospholipase A2(Lp-PLA2)in serum of patients with acute coronary syndrome(ACS)were detected,to discuss the relationship between them and the severity of coronary disease and the diagnostic value of combined detection for AMI.Based on sdLDL-C and Lp-PLA2 as well as routine clinical test items,AMI diagnostic model was established by screening indicators.Methods A total of 168 patients diagnosed with ACS admitted to the Department of Cardiology,Ningxia Medical University General Hospital from October 2019 to November2020 were collected as the experimental group,with an average age of(59.29±10.32)years old,including 110 males and 58 females.During the same period,61 healthy subjects with an average age of(60.72±6.07)years were collected,including 33 males and 28 females.According to clinical diagnosis,the experimental group was divided into 86 patients with unstable angina pectoris(UA)group,with an average age of(59.24±9.71)years,including 56 males and 30 females,and 82 patients with acute myocardial infarction(AMI)group,with an average age of(59.34±10.98)years,including 54 males and 28 females.The AMI group was further divided into non-ST segment elevation myocardial infarction(NSTEMI)subgroup and ST segment elevation myocardial infarction(STEMI)subgroup,50 cases and 32 cases,respectively.According to the number of coronary artery occlusion,the experimental group was divided into one group(34 cases),two groups(59 cases)and three groups(75 cases).According to Gensini score,the experimental group was divided into 1-30 group(60 cases),31-60 group(57 cases),and >60 group(51 cases).General data and examination and examination results on admission were collected for all subjects.Serum concentrations of sdLDL-C and Lp-PLA2 were detected by enzymatic method and continuous detection method,and other indexes were detected by conventional method.By comparing the concentrations of sdLDL-C and Lp-PLA2 in serum among different groups,the correlation between them and the incidence and severity of ACS was investigated.The area under the ROC curve(AUC),sensitivity and specificity of sdLDL-C and Lp-PLA2 were used to evaluate the significance of sdLDL-C and Lp-PLA2 for AMI diagnosis.UA was used as the control group.sdLDL-C,Lp-PLA2 and clinical routine tests were screened by univariate method,and a diagnosis model of AMI was established by multivariate regression analysis.Another 40 ACS patients were collected to verify the stability of the model.Results 1.The experimental group of sdLDL-C,Lp-PLA2,smoking,BMI,the WBC and NEUT %,GLU,UREA,Scr,UA,AST,ALT,TG,level higher than the control group,RDW-CV,HDL-C,LVEF% lower than the control group,and the differences were statistically significant(P<0.05).The experimental group and control group in Sex,Age,SBP,DBP,TC,LDL-C has no statistically significant difference(P>0.05),2.The levels of sdLDL-C and Lp-PLA2 in AMI group were higher than those in UA group and healthy control group(P<0.05).NSTEMI group compared with STEMI group,sdLDL-C,Lp-PLA2 level differences had no statistical significance(P > 0.05).3.The higher the number of lesions,the higher the levels of sdLDL-C,Lp-PLA2 and Gensini score,and the differences between any two groups were statistically significant(P≤0.001).4.There were statistically significant differences in sdLDL-C and Lp-PLA2 among different Gensini scores(P<0.05).5.The levels of sdLDL-C and Lp-PLA2 in the experimental group showed a positive correlation with Gensini score(r=0.235,P=0.002;r=0.239,P=0.002).6.The AUC,sensitivity and specificity of sdLDL-C and Lp-PLA2 combined detection in the diagnosis of AMI were 0.712,66% and70%,respectively.7.Logit(P)=0.284×Glu+0.028×CK+0.976×LDL-C+0.007×sdLDL-C-0.381×EF+12.717.The cutoff value was 0.62,the AUC,sensitivity and specificity were 0.975,90.2% and 93.0%,respectively,and the coincidence rate was 79%.8.The diagnostic efficiency of the model in the validation group: area under the curve,sensitivity specificity were 0.9,88.2%,and 91.3%,respectively.Conclusion 1.Serum sdLDL-C and Lp-PLA2 concentrations are of certain significance in the diagnosis of ACS,especially in assisting in the assessment of the severity of coronary artery lesions in patients with ACS,and can be used for risk stratification of ACS.2.The sensitivity and specificity(90.2%,93%)of the diagnostic model established by GLU,CK,LDL-C,sdLDL-C and LVEF% in predicting the occurrence of AMI were higher than that of cTnI(78.0%,90.7%). |
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