关键词：2008WCHD 14届世界心脏病大会 动脉粥样硬化

      基于动脉粥样硬化复杂的病理生理基础，大量的与血脂，炎症，免疫功能，血栓与止血有关的生物学标志物已经在流行病学研究和临床试验中得以研究证实。
      出于对它们在危险分层中的潜在作用的兴趣，以及潜在的治疗前景的兴趣，最近，两种脂蛋白相关的生物学标记物磷脂酶A2 (Lp-PLA2)和第二类分泌型磷脂酶A (sPLA2)已经备受关注。
      尤其是第二类分泌型磷脂酶A (sPLA2)在大型流行病学数据库中表明能够提高危险分层。
      此外，它还被视作是一种受人关注的治疗靶标，因为它的一种特异性的抑制剂已经在动物实验数据和初步人类积极的研究结果中证明可行。
      生物标志物研究已经完成，并且在各类炎症分子方面显示出了积极作用。
      此外，在治疗超过12月之久的300名冠心病患者中进行的一项建立在（灰度，虚拟组织学和射频成像）基础之上的血管内超声影像学研究和一组生物标志物研究(IBIS-2)已经完成，其结果期待已久。
      同样，动物数据和几种流行病学研究表明第二类分泌型磷脂酶A (sPLA2)有增加动脉粥样硬化风险的可能，使用其抑制剂几个月之后，显示了其对血脂谱和若干炎症血清标志物的积极影响。
      因此，对磷脂酶家族这两个成员致动脉粥样化作用和致炎作用方面的抑制能够降低复方用药高危患者的残余风险。

Based on the complex pathophysiology of atherosclerosis, a large number of biomarkers that relate to lipids, inflammation, immunity, thrombosis and hemostasis, have been investigated experimentally, in epidemiologic studies, and in clinical trials.
     
Interest focuses on their potential role to aid in risk stratification, as possible surrogate markers of atherosclerosis, and potential targets for therapy. More recently, two lipid associated biomarkers, lipoprotein associated phospholipase A2 (Lp-PLA2), and type II secretory phospholipase A (sPLA2) have gained considerable interest. 

In particular for Lp-PLA2 a large epidemiological database suggests that it might improve risk stratification. 

Moreover, it may also serve as an interesting therapeutic target, since a specific inhibitor of the enzyme is available with promising animal data and initial positive data in humans. 

A biomarker study has been completed demonstrating a positive effect on various inflammatory molecules. In addition, an imaging study using IVUS based modalities (greyscale, virtual histology and palpography) together with a panel of biomarkers (IBIS-2) has been done in more than 300 patients with CHD treated over 12 months and results are eagerly awaited. 

Similarly for type II sPLA2 animal data and several epidemiological studies suggest that it may be associated with atherosclerosis risk. Inhibition of the enzyme over several months has demonstrated positive effects on the lipid profile as well as on several proinflammatory biomarkers. 

Thus, inhibition of the proatherogenic and proinflammatory effects of these two members of the phospholipase superfamily may contribute to decrease the residual risk in high risk patients already on a polypharmacy.

来自第14届世界心脏病大会
张伟译 刘琳宁校