目的:分析脂蛋白相关磷脂酶A2(Lp-PLA2)与冠脉粥样硬化严重程度关系,评估不同剂量瑞舒伐他汀对血浆LpPLA2浓度的影响。方法:152例可疑冠心病患者根据冠脉造影检查结果分为冠心病组(n=117)与对照组(无冠心病,n=35)。采取Gensini积分量表,同时参照冠脉病变支数评估患者冠脉粥样硬化程度,并检测患者血浆Lp-PLA2水平,采用多元逻辑回归分析Lp-PLA2水平与冠脉斑块严重程度的相关性。将冠心病组患者再随机分为两组,分别给予常规剂量(10 mg·d~(-1))与负荷剂量(20 mg·d~(-1))瑞舒伐他汀,测定服药后2周、4周、8周及12周血浆Lp-PLA2浓度。结果:对照组血浆LpPLA水平为(22.22±1.75)μmol·ml~(-1),冠心病组为(29.03±3.99)μmol·ml~(-1),差异有统计学意义(P<0.05);冠心病不同Gensini积分组Lp-PLA2水平差异有统计学意义(P<0.05),分值越高,患者Lp-PLA2水平越高。多因素回归分析结果显示,冠脉粥样硬化程度与Lp-PLA2水平呈明显正相关(OR=1.613,P<0.05)。服药2,4,8,12周后,负荷剂量组Lp-PLA2水平均明显低于常规剂量组(P<0.05);冠脉狭窄程度评分明显低于常规剂量组(P<0.05)。常规剂量组心血管不良事件发生率(27.12%)明显高于负荷剂量组(6.90%)(P<0.05);两组药物不良反应发生率差异无统计学意义(11.86%vs 18.97%)(P>0.05)。结论:Lp-PLA2与冠脉斑块严重程度相关,采取大剂量瑞舒伐他汀方案可降低患者血浆Lp-PLA2浓度水平。 OBJECTIVE: To analyze the relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) and the severity of coronary atherosclerosis and evaluate the effect of different doses of rosuvastatin on plasma LpPLA2 concentration. Methods: 152 patients with suspected coronary heart disease were divided into coronary heart disease group (n = 117) and control group (no coronary heart disease, n = 35) according to coronary angiography results. The severity of coronary atherosclerosis was evaluated by Gensini score scale, and the level of Lp-PLA2 in plasma was also measured. The correlation between Lp-PLA2 level and the severity of coronary artery plaque was analyzed by multivariate logistic regression analysis . Patients in coronary heart disease group were randomly divided into two groups. The patients were given rosuvastatin at a dose of 10 mg · d ~ (-1) and a loading dose of 20 mg · d ~ (-1) Week, 4 weeks, 8 weeks and 12 weeks plasma Lp-PLA2 concentration. Results: The level of plasma LpPLA in the control group was (22.22 ± 1.75) μmol · ml -1 and that in the coronary heart disease group was (29.03 ± 3.99) μmol · ml -1, the difference was statistically significant (P0.05) (P <0.05). The higher the score, the higher the level of Lp-PLA2 in patients with coronary heart disease. Multivariate regression analysis showed that the degree of coronary atherosclerosis was positively correlated with Lp-PLA2 level (OR = 1.613, P <0.05). The Lp-PLA2 levels in the loaded dose group were significantly lower than those in the conventional dose group (P <0.05) after 2, 4, 8 and 12 weeks of treatment. The severity of coronary artery stenosis was significantly lower than that of the conventional dose group (P <0.05). The incidence of cardiovascular adverse events in the conventional dose group (27.12%) was significantly higher than that in the loading dose group (6.90%) (P <0.05). There was no significant difference in adverse drug reactions between the two groups (11.86% vs 18.97%, P > 0.05). Conclusion: Lp-PLA2 is correlated with the severity of coronary plaque. High-dose rosuvastatin can reduce the level of Lp-PLA2 in plasma.