CAJ | 학술논문

目的：探讨急性冠状动脉综合征（ACS）患者血浆鞘磷脂水平的变化及其相关性。方法327例胸闷和（或）胸痛患者根据其冠状动脉造影结果以及临床症状分成ACS、稳定型心绞痛以及健康对照组，其中ACS组215例、稳定型心绞痛组57例以及健康对照组55例，采用酶学方法检测三组血浆鞘磷脂，比较各组血浆鞘磷脂水平，并进行相关数据分析。结果（1）ACS组患者血浆鞘磷脂含量（14.00μg/L，9.83～17.54μg/L）比稳定型心绞痛组（8.58μg/L，6.29～13.17μg/L）显著增高（P＜0.001），对照组血浆鞘磷脂含量（8.17μg/L，5.67～13.58μg/L）与稳定型心绞痛组之间无显著性差异（P＝0.735）。（2）多因素Logistic回归分析显示：血浆鞘磷脂浓度与ACS发病危险性有明显相关性（OR 3.695，95% CI 1.848～7.40，P＜0.001）。（3）ROC曲线结果显示：ACS患者血浆鞘磷脂曲线下面积为0.727（0.654～0.800，P＜0.001），对ACS具有一定的诊断价值。结论 ACS组患者血浆鞘磷脂含量明显增高，血浆鞘磷脂水平与ACS的发病具有一定的相关性，提示高血浆鞘磷脂水平可能是预测ACS患者斑块不稳定的标记物之一。
목적：탐토급성관상동맥종합정（ACS）환자혈장초린지수평적변화급기상관성。방법327례흉민화（혹）흉통환자근거기관상동맥조영결과이급림상증상분성ACS、은정형심교통이급건강대조조，기중ACS조215례、은정형심교통조57례이급건강대조조55례，채용매학방법검측삼조혈장초린지，비교각조혈장초린지수평，병진행상관수거분석。결과（1）ACS조환자혈장초린지함량（14.00μg/L，9.83～17.54μg/L）비은정형심교통조（8.58μg/L，6.29～13.17μg/L）현저증고（P＜0.001），대조조혈장초린지함량（8.17μg/L，5.67～13.58μg/L）여은정형심교통조지간무현저성차이（P＝0.735）。（2）다인소Logistic회귀분석현시：혈장초린지농도여ACS발병위험성유명현상관성（OR 3.695，95% CI 1.848～7.40，P＜0.001）。（3）ROC곡선결과현시：ACS환자혈장초린지곡선하면적위0.727（0.654～0.800，P＜0.001），대ACS구유일정적진단개치。결론 ACS조환자혈장초린지함량명현증고，혈장초린지수평여ACS적발병구유일정적상관성，제시고혈장초린지수평가능시예측ACS환자반괴불은정적표기물지일。
Objective To investigate the correlation between the levels of plasma sphingomyelin and coronary lesion in patients with acute coronary syndrome(ACS). Methods 327 subjects with the main complaint of chest pain, according to clinical symptoms and the result of coronary artery angiography, were devided into three different groups. 215 cases were selected and classified in acute coronary syndrome group (ACS group), 57 cases in stable angina pectoris group (SAP group) and another 55 cases in normal control group with atypical chest pain and normal coronary artery. The plasma sphingomyelin level was detected and analyzed among each groups. Results (1) Plasma sphingomyelin level in the ACS group(14.00μg/L, 9.83-17.54μg/L) was significantly higher(P<0.001) compared with the SAP group(8.58μg/L, 6.29-13.17μg/L), and there was no significant difference(P=0.735) between SAP group and control groups(8.17μg/L, 5.67-13.58μg/L). (2) Multivariable logistic regression analyses according to different covariates revealed a significant independent relation between plasma SM levels and the presence of ACS(OR 3.695, 95% CI 1.848-7.40, P<0.001). (3) The ROC curves of plasma sphingomyelin level in the ACS group showed an area under the curve of 0.727(0.654-0.800, P<0.001), suggesting a predictive value of plasma sphingomyelin level in assessment of the progression of ACS. Conclusions The level of plasma sphingomyelin is significantly higher in the ACS group, and may associated with development of ACS. These findings probably suggested that the increased level of plasma sphingomyelin may be serum markers to evaluate the ACS, and has some predictive value for coronary plaque stability.