Gerber Yariv, McConnell Joseph P, Jaffe Allan S, Weston Susan A, Killian Jill M, Roger Véronique L
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
Arterioscler Thromb Vasc Biol. 2006 Nov;26(11):2517-22. doi: 10.1161/01.ATV.0000240406.89440.0c. Epub 2006 Aug 10.
We evaluated the role of lipoprotein-associated phospholipase A2 (Lp-PLA2), an inflammatory biomarker, in defining risk after myocardial infarction (MI).
Olmsted County, Minn, residents who experienced an MI meeting standardized criteria between 2003 and 2005 (n = 271) were prospectively identified and followed. Lp-PLA2 levels were measured at baseline and evaluated along with traditional risk indicators. Lp-PLA2 was modestly associated with total and low-density lipoprotein cholesterol, smoking, and age (inversely) but not with MI characteristics or severity, comorbidities, C-reactive protein, or the time from symptom onset to blood sampling. During the first year of follow-up, 42 deaths occurred. The survival estimates (95% confidence intervals [CI]) at 1 year were 92% (86% to 98%), 85% (78% to 93%), and 74% (65% to 84%) in the lowest, middle, and upper Lp-PLA2 tertiles, respectively (P = 0.007). After adjustment for age and sex, the hazard ratios for death in the middle and upper Lp-PLA2 tertiles were 2.20 (95% CI: 0.88 to 5.54) and 4.93 (95% CI: 2.10 to 11.60), compared with the lowest tertile, respectively (P(trend) < 0.001). Further adjustment for other risk indicators resulted in even stronger associations. Lp-PLA2 also contributed to risk discrimination as indicated by the increases in the area under the receiver operating characteristic curves obtained in each of the models examined (all P < or = 0.05).
Among community subjects presenting with MI, increased Lp-PLA2 levels measured early after MI are strongly and independently associated with mortality and provide incremental value in risk discrimination over traditional predictors.
我们评估了炎症生物标志物脂蛋白相关磷脂酶A2（Lp-PLA2）在定义心肌梗死（MI）后风险中的作用。
前瞻性地确定并随访了2003年至2005年间明尼苏达州奥尔姆斯特德县符合标准化标准的心肌梗死患者（n = 271）。在基线时测量Lp-PLA2水平，并与传统风险指标一起进行评估。Lp-PLA2与总胆固醇和低密度脂蛋白胆固醇、吸烟及年龄（呈负相关）有适度关联，但与心肌梗死的特征或严重程度、合并症、C反应蛋白或从症状发作到采血的时间无关。在随访的第一年，发生了42例死亡。Lp-PLA2三分位数最低、中间和最高组在1年时的生存估计值（95%置信区间[CI]）分别为92%（86%至98%）、85%（78%至93%）和74%（65%至84%）（P = 0.007）。在调整年龄和性别后，Lp-PLA2三分位数中间和最高组的死亡风险比分别为2.20（95% CI：0.88至5.54）和4.93（95% CI：2.10至11.60），与最低三分位数相比（P趋势<0.001）。对其他风险指标进行进一步调整后，关联更强。Lp-PLA2也有助于风险判别，在所检查的每个模型中，受试者操作特征曲线下面积均增加（所有P≤0.05）。
在出现心肌梗死的社区受试者中，心肌梗死后早期测量的Lp-PLA2水平升高与死亡率密切且独立相关，并且在风险判别方面比传统预测指标具有增量价值。
