血清Hcy、sdLDL-C、Lp-PLA2水平对短暂性脑缺血发作进展为急性脑梗死的预测效能

Predictive effect of serum Hcy,sdLDL-C,and Lp-PLA2 levels on the progression of transient ischemic attack to acute cerebral infarction

目的:分析血清同型半胱氨酸(Hcy)、小而密低密度脂蛋白胆固醇(sdLDL-C)、脂蛋白相关磷脂酶A2(Lp-PLA2)水平对短暂性脑缺血发作(TIA)进展为急性脑梗死的预测效能。方法:随机选取徐州市中心医院神经内科自2018年2月至2020年6月收治的223例TIA患者记为研究组,另随机选取同期健康体检者191例记为对照组。对研究组患者进行12个月的随访,将进展为急性脑梗死的TIA患者归为进展组,余者归为未进展组。采用秩和检验比较初诊时研究组与对照组以及进展组和未进展组血清Hcy、sdLDL-C、Lp-PLA2水平的差异;采用Logistic回归分析研究组随访12个月内进展为急性脑梗死的危险因素;绘制受试者工作特征(ROC)曲线,分析血清Hcy、sdLDL-C、Lp-PLA2对TIA进展为急性脑梗死的预测效能。结果:初诊时研究组血清Hcy、sdLDL-C、Lp-PLA2水平均高于对照组[(14.57(9.46,18.92)μmol/L vs 10.08(5.75,13.29)μmol/L、1.28(1.11,1.59)mmol/L vs 0.37(0.32,0.41)mmol/L、186.18(146.34,212.16)μg/L vs 132.53(77.34,159.05)μg/L],差异具有统计学意义(U=25.697、53.784、39.621,P均<0.001);研究组患者发病后12个月内进展为急性脑梗死的发生率为25.11%(55/219);进展组血清Hcy、sdLDL-C、Lp-PLA2水平均高于未进展组[20.86(13.43,23.85)μmol/L vs 13.79(11.86,15.57)μmol/L、2.63(1.41,3.26)mmol/L vs 1.23(1.06,1.40)mmol/L、216.84(185.40,239.45)μg/L vs 183.12(132.51,191.25)μg/L],差异具有统计学意义(U=14.596、30.089、22.047,P均<0.001);伴颈动脉斑块、伴脑动脉狭窄、伴心律失常、发作次数>3次、合并高血压病、合并糖尿病、合并高脂血症、吸烟史、饮酒史、血清Hcy水平、血清sdLDL-C水平、血清Lp-PLA2水平均是TIA患者进展为急性脑梗死的影响因素[比值比(OR)=4.116、3.414、2.622、3.180、2.863、2.633、2.998、2.073、2.002、4.216、4.693、4.371,P均<0.05];血清Hcy、sdLDL-C、Lp-PLA2水平预测TIA进展为急性脑梗死的最佳截断值分别为17.36μmol/L、1.76 mmol/L、199.84μg/L,血清Hcy、sdLDL-C、Lp-PLA2水平联合预测TIA进展为急性脑梗死的敏感度、曲线下面积(AUC)分别为98.18%和0.956,均高于单独预测(敏感度=69.09%、65.45%、67.27%,AUC=0.849、0.810、0.791,P均<0.05),特异度与单独预测对比差异均无统计学意义(P均>0.05)。结论:TIA患者血清Hcy、sdLDL-C、Lp-PLA2水平升高,进展为急性脑梗死的TIA患者上述指标水平更高,三者与合并高血压病等因素均可增加TIA进展为急性脑梗死的风险,且三者联合对TIA进展为急性脑梗死的预测价值高于单独预测,尤其是当血清Hcy、sdLDL-C、Lp-PLA2水平分别高于17.36μmol/L、1.76 mmol/L、199.84μg/L时更需增加对患者的风险管理。

Objective To analyze the predictive effect of serum homocysteine(Hcy),small dense low density lipoprotein cholesterol(sdLDL-C)and lipoprotein associated phospholipase A2(Lp-PLA2)levels on the progression of transient ischemic attack(TIA)to acute cerebral infarction.Methods 223 patients with TIA admitted to the Neurology Department of Xuzhou Central Hospital from February 2018 to October 2020 were randomly included as the study group,and 191 healthy people in the same period were randomly included as the control group.The patients in the study group were followed up for 12 months,and the TIA patients who progressed to acute cerebral infarction were classified as the progression group,and the rest were classified as the non-progression group.The serum levels of Hcy,sdLDL-C,and Lp-PLA2 were compared between the study group at initial diagnosis and the control group,and between the progression group and non-progression group by rank test.The risk factors of developing acute cerebral infarction within 12 months follow up in the study group were analyzed by Logistic resgression.The receiver operating characteristic(ROC)curve was performed to explore the predictive efficacy of serum Hcy,sdLDL-C,and Lp-PLA2 on the progression of TIA to acute cerebral infarction.Results The serum Hcy,sdLDL-C,and Lp-PLA2 levels in the study group at initial diagnosis were higher than those in the control group[14.57(9.46,18.92)μmol/L vs 10.08(5.75,13.29)μmol/L,1.28(1.11,1.59)mmol/L vs 0.37(0.32,0.41)mmol/L,186.18(146.34,212.16)μg/L vs 132.53(77.34,159.05µg/L);U=25.697,53.784,39.621;all P<0.001)].The incidence of acute cerebral infarction was 25.11%(55/219)in the study group within 12 months follow up.The serum levels of Hcy,sdLDL-C,and Lp-PLA2 in the progression group were higher than those in the non-progression group[20.86(13.43,23.85)μmol/L vs 13.79(11.86,15.57)μmol/L,2.63(1.41,3.26)mmol/L vs 1.23(1.06,1.40)mmol/L,216.84(185.40,239.45)μg/L vs 183.12(132.51,191.25)μg/L;U=14.596,30.089,22.047;all P<0.001].Carotid artery plaque,cerebral artery stenosis,arrhythmia,number of attacks>3 times,hypertension,diabetes mellitus,hyperlipidemia,smoking history,drinking history,serum Hcy level,serum sdLDL-C level and serum Lp-PLA2 level were all influencing factors of TIA patients'progression to acute cerebral infarction[odds ratio(OR)=4.116,3.414,2.622,3.180,2.863,2.633,2.998,2.073,2.002,4.216,4.693,4.371,respectively,all P<0.05].The optimal cut-off values of serum Hcy,sdLDL-C,and Lp-PLA2 levels for predicting TIA progression to acute cerebral infarction were 17.36μmol/L,1.76 mmol/L,and 199.84μg/L,respectively.The joint sensitivity and area under the curve(AUC)of serum Hcy,sdLDL-C,and Lp-PLA2 levels in predicting TIA progression to acute cerebral infarction were 98.18%and 0.956,respectively,which were higher than those in predicting TIA progression to acute cerebral infarction alone(sensitivity=69.09%,65.45%,67.27%,respectively;AUC=0.849,0.810,0.791,respectively;P<0.05).Still,there was no statistical difference in the specificity between single and the independent prediction(P>0.05).Conclusion The levels of serum Hcy,sdLDL-C,and Lp-PLA2 in patients with TIA increased,and the levels of the indicators above in patients with TIA who will develop acute cerebral infarction are higher.The three indicators above and hypertension and so on can increase the risk of TIA developing into acute cerebral infarction,and the combined prediction value of the three is higher than that of individual prediction.Especially when the serum Hcy,sdLDL-C,and Lp-PLA2 levels were higher than 17.36μmol/L,1.76 mmol/L,199.84μg/L,it is more necessary to increase the risk management of patients.