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目的：研究血浆磷脂酶A2（plasma phospholipase A2，PLA2）与糖尿病合并心肌梗死（myocardial infarction, MI）患者预后关系。方法：前瞻性研究分析2009 年6 月至2012 年9 月期间入住我院心内科或内分泌科158 例半年内有MI病史的患者根据有无 2型糖尿病分为糖尿病合并MI患者组（80 例）与单纯MI患者组（对照组，78 例）。两组患者均在6 个月内因急性MI 在我院行经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）并置入药物涂层支架。观察两组患者PLA2 的水平，分析其与患者心功能的变化及预后的相关性。两组患者行2 年随访，随访结束后通过K-M 模型观察组间心血管不良事件（major adverse cardiovascular events, MACE）的发生率，将单因素分析有意义的变量包括，PLA2、高血压、低密度脂蛋白、吸烟、性别、年龄、超敏C 反应蛋白、肾小球滤过率、白细胞计数等纳入Cox比例风险回归模型对预后进行多因素分析。结果：糖尿病合并MI 组患者PLA2 的水平显著高于单纯心肌梗死组（11.67± 4.26 滋g/L vs. 5.36± 1.1 滋g/L，P<0.001）。这些患者外周血中CD14+单核细胞亦显著高于单纯心肌梗死组（53.36 %± 17.41%vs.35.23 %± 11.57 %，P<0.001）。糖尿病合并MI组患者血浆磷脂酶A2的水平与患者心功能呈负相关（r=-0.25，P=0.02），而单纯MI患者组未显示统计学意义（r=-0.20，P=0.07）。Kaplan-Meier生存分析显示糖尿病合并MI患者主要心血管不良事件的发生率明显高于单纯心肌梗死组（P=0.046）。通过COX 模型分析影响生存因素发现血浆磷脂酶A2 （HR:4.29，95 %CI: 2.305-7.975，P<0.001）仍与这些患者心血管不良事件发生显著相关。结论：血浆磷脂酶A2反应糖尿病合并MI 患者体内的炎症剧烈程度，高水平的血浆高磷脂酶A2 与糖尿病合并MI患者的预后密切相关。

英文摘要:

Objective:To observe the association of plasma phospholipase A2 (PLA2) and the prognosis of diabetic patients with myocardial infarction (MI).Methods:158 cases of patients undergoing acute myocardial infarction (AMI) within 6 months are divided into diabetes with MI group (80 cases) and MI group (control, 78 cases). All patients accepted percutaneous coronary intervention (PCI) and were placed with drug-eluting stents within 6 months. Phospholipase A2 in the plasma was examined to analyze its possible relationship with cardiac function and the prognosis of the patients. Two groups of patients were followed up for 2 years. Afterwards, K-M model was used to estimate the difference of major adverse cardiovascular events (MACE) incidence. Cox proportional-hazard models were used to analyze the relationship of PLA2 and event-free survivals after adjusting for confounding factors including high blood pressure, low density lipoprotein (LDL), smoking, sex, age, high-sensitivity C-reactive protein (hs-CRP), estimated glomerular filtration rate (eGFR), white blood cell count, etc.Results:Plasma levels of phospholipase A2 in diabetic patients with MI were significantly higher than control (11.67 ± 4.26 滋g/L vs. 5.36 ± 1.1 滋g/L, P<0.001). The patients showed higher levels of peripheral blood CD14+ monocytes (53.36 % ± 17.41 % vs.35.23 % ± 11.57 %, P<0.001) compared to control. Phospholipase A2 in diabetic patients with MI was negatively correlated with left ventricular ejection fraction (LvEF)% (r = -0.25, P= 0.02). But no statistical significance was shown in MI patients (r = -0.20, P= 0.07) . Kaplan-Meier survival analysis further showed significant difference of major cardiovascular adverse events incidence between the groups (P= 0.046). COX Model further revealed that plasma phospholipase A2 (95 % CI: 2.305-7.975, P<0.001) was associated with cardiovascular adverse events in this group.Conclusion:Plasma phospholipase A2 is predicative for the severity of inflammation in diabetic patients with MI. And high levels of plasma high phospholipase A2 are closely related to the prognosis of these patients.

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