急性缺血性脑血管病患者ox-LDL、PAPP-A表达及与神经功能缺损程度的相关性研究

Study on the expression of ox-LDL and PAPP-A in patients with acute ischemic cerebrovascular disease

目的探讨急性缺血性脑血管病(AICVD)的氧化型低密度脂蛋白(ox-LDL)、妊娠相关血浆蛋白(PAPP-A)表达及与神经功能缺损程度的相关性。方法前瞻性研究,选取开滦总医院神经内科于2016年1月至2018年1月收治的AICVD患者103例进行临床实验,视作实验组(A组),选同期入院健康体检者105例志愿者对照,视作对照组(B组),将两组各项临床资料、基线数据等纳入SPSS21.0软件处理,ox-LDL和PAPP-A表达均采用酶联免疫吸附法(ELISA)检测,两者与神经功能缺损程度的相关性分析则采用Logistic回归分析。结果①A组入院后24h的ox-LDL、PAPP-A表达均分别高于治疗后7d、15d,A组ox-LDL、PAPP-A表达较B组均更高(P<0.05);②不同病理改变下颈动脉斑块组的oxLDL、PAPP-A表达水平较IMT增厚组、IMT正常组更高(P<0.05),易损斑块组的ox-LDL、PAPP-A表达水平较稳定斑块组更高(P<0.05);③从不同病理改变下的ox-LDL、PAPP-A表达水平比较来看,NIHSS评分等级越高,ox-LDL、PAPP-A表达水平越高。Spearman分析检验,ox-LDL与PAPP-A水平呈正相关(r=0.836,P<0.05)。将是否存在AICVD和神经功能缺损作为因变量,将年龄、性别、ox-LDL与PAPP-A等作为自变量的Logistic回归分析发现,NIHSS评分等级与ox-LDL、PAPP-A呈正相关(OR=2.512,1.12<95%CI<3.74;OR=1.312,1.10<95%CI<2.72,P<0.05)。结论AICVD患者神经缺损程度的发生、发展与ox-LDL、PAPP-A表达高低呈正相关,神经缺损越严重ox-LDL、PAPP-A表达越高,故可推断ox-LDL、PAPP-A表达在神经功能缺损的发生、发展过程中起协同作用,可将其视作神经功能缺损程度的实验室检测方法之一。

Objective To investigate the expression of ox-LDL and PAPP-A in patients with acute ischemic cerebrovascular disease(AICVD)and their relationship with the degree of neurological deficit.Methods In a prospective study,103 patients with AICVD who were admitted to the Department of Neurology of Kailuan general hospital from January 2016 to January 2018 were selected for clinical experiment as experimental group(group A).105 volunteers who were admitted to the hospital for physical examination at the same time were selected as control group(group B).The clinical data and baseline data of the two groups were included in spss21.0 software for processing.The expression of ox LDL and PAPP-A were all expressed by enzyme The correlation between the two and the degree of neurological deficit was analyzed by Logistic.Result①The expression of ox-LDL and PAPP-A in group A was higher than that in group B(P<0.05);②Under different pathological changes,the expression level of ox-LDL and PAPP-A in carotid plaque group was higher than that in IMT thickening group and IMT normal group(P<0.05),and the expression level of ox-LDL and PAPP-A in vulnerable plaque group was higher than that in stable plaque group(P<0.05);③From the comparison of the expression levels of ox-LDL and PAPP-A under different pathological changes,the higher the NIHSS score,the higher the expression levels of ox-LDL and PAPP-A(see Table 4).Spearman analysis showed that ox-LDL was positively correlated with PAPP-A(r=0.836,P<0.05).According to the Logistic regression analysis with age,sex,ox-LDL and PAPP-A as independent variables,whether there is AICVD and neurological deficit or not was found to be positively correlated with the scores of NIHSS(or=2.512,1.12<95%CI<3.74;or=1.312,1.10<95%CI<2.72,P<0.05).Conclusion The occurrence and development of neurological deficit in patients with AICVD is positively correlated with the expression of ox-LDL and PAPP-A.the more serious the neurological deficit is,the higher the expression of ox LDL and PAPP-A is.Therefore,it can be inferred that the expression of ox LDL and PAPP-A plays a synergistic role in the occurrence and development of neurological deficit,which can be regarded as one of the laboratory methods to detect the degree of neurological deficit.