Correlation Research Between Human Plasma Lipoprotein Phospholipase A2,C-reactive Protein And Patients With Coronary Atherosclerotic Heart Disease Complicated With Type 2 Diabetes Mellitus

Objective: To investigate the expressions of human plasma lipoprotein phospholipase A2(Lp-PLA2)and C-reactive protein(CRP)in patients with coronary atherosclerotic heart disease(CHD)complicated with type 2 diabetes mellitus(T2DM)and to explore the potential clinical significance.Methods: This is a retrospective study.A total of 1051 hospitalized patients from department of Cardiovascular Medicine in Affiliated Hospital of Qingdao University were enrolled after selection.CHD was diagnosied by transcoronary angiography showing ≥50%stenosis of one or more coronary artery and its major branches.T2DM was diagnosed base on the Guidelines for the Prevention and Treatment of Type 2 Diabetes in China(2017 Edition).According to whether diagnosed with CHD and T2DM,participants were divided into four groups: 268 cases of the control group,263 cases of the CHD group,234 cases of the T2DM group,286 cases of the CHD complicated with T2DM group.The admission time,age,gender,body mass index(BMI),systolic blood pressure,diastolic blood pressure,smoking history,drinking history,physical activity history,personal history,drug use history,etc.of the four groups were collected.These laboratory indicators were collected:triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),lipoprotein(a)[LP(a)],fasting blood glucose(FBG),human plasma lipoprotein phospholipase A2(Lp-PLA2),C-reactive protein(CRP),etc.The differences of the levels of Lp-PLA2 and CRP were compared among four groups.The interaction effects of CHD group and T2DM group on Lp-PLA2 levels and CRP levels were analyzed by variance analysis with factorial design.The correlations between LpPLA2,CRP levels and Gensini score were analyzed.Logistic regression was used to analyze the effects of Lp-PLA2 and CRP on the occurrence of CHD complicated with T2DM.The receiver operating characteristic(ROC)curve was applied to analyze the predictive value of Lp-PLA2 and CRP on the occurrence of CHD complicated with T2DM.SPSS 22.0 was used for data statistical analysis,and ROC was drawn with Med Calc software.Results: There were statistically significant differences in BMI,systolic blood pressure,diastolic blood pressure,TG,TC,LDL-C,HDL-C,LP(a)and FBG among the four groups(P < 0.05).BMI,TG,TC,LDL-C,LP(a)in CHD+T2DM group were higher than those in CHD group and T2DM group(P < 0.05).The levels of Lp-PLA2 and CRP were significantly different among four groups.The levels of Lp-PLA2 and CRP in the CHD complicated with T2DM group were significantly higher than those in the other groups(P<0.05).Meanwhile,the number of narrow vessels and Gensini score in the combined group were higher than those in the CHD group(P < 0.05).Analysis of variance by factorial design showed that there exist interaction effects between CHD group and T2DM group in not only Lp-PLA2 but also CRP level(F=9.67,P=0.002;F=6.40,P=0.012).Correlation analysis showed that Lp-PLA2 and CRP levels were positively correlated with Gensini score in CHD group(r=0.19,0.17,P < 0.05),and Lp-PLA2 and CRP levels were also positively correlated with Gensini score in CHD+T2DM group(r=0.22,0.26,P < 0.05),and the correlation was stronger in CHD+T2DM group.Logistic regression analysis showed that Lp-PLA2 and CRP were risk factors for CHD complicated with T2DM(LpPLA2:OR = 1.029,95% CI: 1.021 ～ 1.037,P <0.001;CRP:OR = 1.668,95% CI:1.376～2.022,P <0.001).The area under the ROC curve of Lp-PLA2,CRP and combined detection of them for the prediction of CHD combined T2DM was 0.814,0.790,0.921,respectively.Using Lp-PLA2 = 179μg/l and CRP = 5.1mg/l as the cut-off values,the sensitivities were 65.03% and 67.13% and the specificities were 88.06% and 82.46%,respectively.The sensitivity and specificity of a combination of Lp-PLA2 and CRP were80.77% and 89.55%.Conclusion: Compared with CHD group,patients in the CHD complicated with T2DM group had more narrow vessels and higher Gensini score.Lp-PLA2 and CRP were the risk factors for CHD combined with T2DM.The combined detection of Lp-PLA2 and CRP can improve the sensitivity and specificity of predicting the occurrence of CHD complicated with T2DM.