The Relationgship Between Plasma Lipoprotein-associated Pospholipase A2and Atherosclerosis And The Therapy Of Atorvastatin In Patients Undergoing PCI

BackgroundCoronary heart disease is a serious threat to human health. As the important means for treatment of coronary heart disease, PCI(percutaneous coronary intervention) were more and more applied to the clinical practice.With the increasing number of PCI procedures, recurrent cardiovascular events which stent restenosis or non-target lesion leding to was increasing year by year. Therefore, incipiently and effectually postoperative forecasting disease progression could be particularly important.It is found that CHD(coronary heart disease) is a chronic inflammatory disease of coronary atherosclerosis, and in this process inflammatory factor plays an very important role.Inflammation factors such as Lipoprotein-associated phospholipase A2(Lp-PLA2) are involved in various stages of atherosclerosis. Relevant evidence suggests Lipoprotein-associated phospholipase A2(Lp-PLA2) is a very useful plasma inflammatory marker correlated with coronary heart disease.Lp-PLA2may be both a specific marker and a causal mediator of plaque progression and instability.Thus, the study of Lipoprotein-associated phospholipase A2(Lp-PLA2) may mark inflammatory, predict atherosclerosis and estimate development of cardiovascular events. Stains play a significant role in anti-inflammatory,vascular endothelial protection and the plaque stabilization.Thus stains was widely used as one of the important measures of atherosclerosis treatment.In recent years, animal studies have found that the protective effect of statin drugs for reperfusion injury may be weakened because of the extension of the time, so perioperative loading dose statin therapy may be more rapid and effective inhibition of the inflammatory response and bring more clinical benefits.ObjectiveThe aim is to elucidate the association of serum Lp-PLA2activity with progression of nonculprit lesions and SYNTAX score after initial percutaneous coronary intervention in patients with CHD; to investigate possible mechanisms for the pathogenesis of progression of nonculprit lesions after initial percutaneous coronary intervention(PCI) in patient with CHD.The effect of different doses of atorvastatin on Lp-PLA2activity, blood lipid and prognosis in patients with CHD.MethodsOur study comprised116patients with coronary heart disease treated with initial PCI. Before PCI for the first time, all patients were randomly assigned to loading dose atorvastatin group and the control group taking conventional-dose statin drugs, and the fasting blood sample would be collected and hs-CRP, blood glucose, blood lipids, renal function and the activity of Lp-PLA2would be determined.Then the cardiovascular risk factors were aslo recorded. One month later the fasting blood sample would be re-collected and hs-CRP, blood lipids, and the activity of Lp-PLA2would be also re-determined.About one year later, all patients were carried out secondary coronary angiography and the major cardiovascular events were recorded.The patients were further divided into progressor group (15patients) and nonprogressor group (101patients) according to the results of Coronary angiography. Results1.Compared with nonprogressor group,the levels of Lp-PLA2activity were significantly higher in the progressor group.(P all<0.01);2.As Coronary lesions aggravating and SYNTAX score increaseing, the levels of LP-PLA2activity gradually increased and the incidence of non-target lesions progress raised.(P all<0.05)3.The Lp-PLA2activity significantly correlated positively with age,TG, cholesterol, LDL-ch,and tended to be associated negatively with HDL-ch.4.One month after PCI, serum TC, LDL, Lp-PLA2activity of loading dose atorvastatin therapy group were significantly lower than control group.(p<0.05) It was found that the nonculprit lesion progression of dayton clothing group was significantly reduced than the control group non-criminal lesion(t=5.251p<0.01) and so was the cardiovascular events possibility of postoperative incidence (P<0.05).Conclusion1.LP-PLA2activity may be related to the progression of nonculprit lesions after initial percutaneous coronary intervention and multiple complex lesions and hypercholesterolemia.2.LP-PLA2activity was independent predictor of progression of nonculprit after initial percutaneous coronary intervention(PCI).3.Perioperative loading dose atorvastatin therapy further reduced levels of serum Lp-PLA2activity and the cardiovascular events possibility of postoperative incidence.