AIM   To investigate the clinical values of lipoprotein-associated phospholipase A2 (Lp-PLA2), D-dimer (D-D), fibrinogen (Fg) and D-dimer/fibrinogen (D/F) ratio for diagnosis of coronary artery lesion and vulnerable plaques in patients with coronary heart disease (CHD).

  METHODS   One hundred and ten CHD patients admitted to Langfang Fourth People’s Hospital for chest pain or chest distress from January 2018 to August 2020 were selected and they were assigned to 3 groups: mild lesion group (n=49), moderate lesion group (n=32) and severe lesion group (n=29), with 50 healthy examination volunteers as control. According to the intravascular ultrasound (IVUS) results, the patients were divided into 2 groups: stable plaque group (n=57) and vulnerable plaque group (n=53). Serum levels of Lp-PLA2, D-D, Fg and D/F ratio were detected and compared between the lesion groups. The differences of plaque characteristic indexes were compared between stable plaque group and vulnerable plaque groups. The correlation and predictive efficiency of Lp-PLA2, D-D, Fg, and D/F ratio with coronary artery lesions and vulnerable plaques were evaluated by Pearson correlation coefficient and ROC curve, respectively. Multivariate logistic stepwise regression was used to analyze the risk factors of coronary artery lesions and vulnerable plaques.

  RESULTS   Lp-PLA2, D-D, Fg, D/F ratio and Gensini score in CHD subgroups were higher than those in control group (P<0.05) and the difference was statistically significant between groups of different degrees of coronary artery lesions (P<0.05). Plaque load, vascular remodeling index and eccentricity index in vulnerable plaque group were higher than those in stable plaque group (P<0.05) and fibrous cap thickness in vulnerable plaque group was lower than that in stable plaque group (P<0.05). Pearson correlation analysis showed that Lp-PLA2, D-D, Fg and D/F ratio were positively correlated with coronary Gensini score, plaque load, vascular remodeling index and eccentricity index, and were negatively correlated with fibrous cap thickness (P<0.05). Multivariate logistic stepwise regression analysis showed that LP-PLA2, D-D, Fg and D/F ratio were independent risk factors for moderate to severe coronary artery lesions and vulnerable plaques. ROC curve showed that AUC of combined LP-PLA2, D-D, Fg and D/F ratio was higher than that of one single index in predicting moderate to severe lesions and vulnerable plaques.

  CONCLUSION   LP-PLA2, D-D, Fg and D/F ratio in patients with CHD are closely correlated with the degree of coronary artery lesion and the plaque vulnerability, and could be used as the reliable markers to predict the degree of coronary artery lesion and plaque vulnerability.