The Study On The Relationship Between SPLA2,hs-CRP And Coronary Pathological Changes And Clinical Significance

Background:Coronary artery disease (CAD) is one of the principal diseases that threaten human health so much that it's the primar cause of death in some countries. At present, the pathogenesy of CAD is not fully studied. Current studies have shown that inflammation plays an essential role in the development and procedure of CAD. The extent of pathological changes and vulnerability of plaque can be determined indirectly by serum inflammatory factor level.As one of the inflammation factors,secretory type II phosphatidolipase A2, a subtype of lipoprotein-related phosphatidolipase A2, is mainly produced by smooth muscle cells and macrophages and belongs to calcium-depended phosphatidolipase family, which locates mainly in macrophages gathering place, lipid core area and extracellular matrix of pathological intima. Currently, it's thought to be related with the development of atherosclerosis by possibly hydrolyzing cellular membrane and phosphatidylcholine in lipoprotein to produce proinflammatory reaction and atherosclerotic lysophosphatidylcholine (LysoPC) and oxidized fatty acid (OxFA) [1]. Increasing evidence has shown that hs-CRP plays an important role in the development of CAD which is considered as An independent prediction factor because its serum concentrated-depende- nt relationship with cardiovascular events[2,3].Objective:This study aimed to study the character of serum level changes of sPLA2 and hs-CRP in every group patients with CAD, the dependability between atherosclerotic plaque features and serum levels of sPLA2 and hs-CRP, and the influence of intervention therapy on serum levels of sPLA2 and hs-CRP. To explore the role of sPLA2 and hs-CRP in CAD pathogenesy and the value of serum level of sPLA2 and hs-CRP in CAD diagnosis and theropy.Methods:One hundred and four patients (male 66, female 38) with CAD were enrolled in this study including stable angina (SA) 28, unstable angina (UA) 54 and acute myocardium infarction (22). All patients underwent coronary angiography with pathological changes in at least one coronary artery. Intravascular ultrasound (IVUS) was performed before percutaneous coronary intervention (PCI) in partly patients. In addition, 20 patients with normal CAG served as control.5 ml of blood was taken from all patients without food over 10 h before blood taken. Blood was taken before and 0, 6, 24h after intervention, respectively. Serum sPLA2 level was measured by double antibody enzyme linked immunoysorbent assay (ELISA) and hs-CRP by emulsion reinforced immunoturbidimetry (ITM). All results were statistically analyzed with SPSS 11.5. P<0.05 was considered statistic difference , P<0.01 was considered significantly statistic difference.Results:1. Compared with each other, serum levels of sPLA2 and hs-CRP are statistically different in AMI, UA, SA and NS groups (p<0.01).The positive standard of sPLA2 is considered as 50pg/ml, positive ratio is 100%, 90%, 55% and 5% in AMI, UA , SA and NS group.2. Serum levels of sPLA2 and hs-CRP didn't change much before and after intervention in NS group while in the patients with PCI the serum levels of sPLA2 and hs-CRP increased significantly after intervention (p<0.01) (in AMI group, p<0.05 compared with those before imtervention).3. Serum levels of sPLA2 and hs-CRP were statistically higher in soft plaque group compared with fibrous plaque group and calcified plaque group (p<0.01). In fibrous plaque group, serum levels of sPLA2 and hs-CRP were significantly higher than those in calcified plaque group, p<0.01 and p<0.05, respectively. The same as that, in afferens plaque group and eccentricity plaque group.Conclusions:1. sPLA2 and hs-CRP play important roles in the development of CAD and can be considered as a predict factor in the diagnosis of CAD.2. PCI results in intima damage in coronary artery and plaque rupture and triggers or aggravates local inflammation reaction. sPLA2 and hs-CRP took part in local inflammation in coronary artery .The serum level of sPLA2 and hs-CRP may indirectly reflect local inflammation in coronary artery.3. Serum levels of sPLA2 and hs-CRP could reflect plaque characters such as eccentricity and vulnerability.