妊娠相关血浆蛋白-A与颈动脉粥样硬化斑块及缺血性脑血管病的关系

Relationship between pregnancy-associated plasma protein-A and carotid atherosclerotic plaque and ischemic cerebrovascular disease

目的探讨血清妊娠相关血浆蛋白(PAPP)-A与颈动脉粥样硬化斑块及缺血性脑血管病(ICVD)的关系。方法116例首次发生颈内动脉系统ICVD的住院患者,包括急性脑梗死(ACI)72例和短暂性脑缺血发作(TIA)44例,另选38例体检者(对照组),均行头颅CT、颈动脉彩色多普勒超声仪及血清PAPP-A检查;根据颈动脉彩色多普勒超声仪检查结果,按斑块性质分为易损斑块组(39例)、稳定斑块组(60例)、内-中膜增厚组(20例)及无斑块组(35例),并对各项检查结果进行组间比较。结果血清PAPP-A水平,ACI组[(5.64±1.92)mIU/L]及TAI组[(5.51±2.01)mIU/L]明显高于对照组[(4.12±1.98)mIU/L](均P<0.05);各组中易损斑块组的血清PAPP-A水平明显高于无斑块组、内-中膜增厚组及稳定斑块组(均P<0.05)。PAPP-A对易损斑块、ACI、TIA的诊断评估显示曲线下面积(AUC)分别为0.87、0.61及0.57。结论血清PAPP-A水平可作为诊断颈动脉粥样硬化易损斑块存在的生物学标记物,其血清水平的升高可视为ICVD的危险因素之一。

Objective To investigate the relationship between pregnancy-associated plasma protein（PAPP-A）and carotid atherosclerotic plaque and ischemic cerebrovascular disease（ICVD）.Methods 116 patients with first onset of ICVD in carotid artery system,including 72 cases with acute cerebral infarction（ACI group）and 44 cases with transient ischemic attck（TIA group）,and 38 subjects（control group）were detected by craniocerebral CT and carotid color Doppler ultrasonography.And the serum PAPP-A of them were also be measured.According to carotid color Doppler ultrasound,the ICVD patients were divided into vulnerable plaque group（39 cases）,stable plaque group（60 cases）,intima-media thickened group（20 cases）and no plaque group（35 cases）.And the results of them were compared with each group.Results The levels of serum PAPP-A of ACI group[（5.64±1.92）mIU/L]and TIA group[（5.51±2.01）mIU/L]were both significantly higher than control group[（4.12±1.98）mIU/L]（all P〈0.05）.In each group,the level of serum PAPP-A of vulnerable plaque group was significantly higher than no plaque group,intima-media thickened group and stable plaque group（all P〈0.05）.The diagnostic assessment of PAPP-A showed the areas under the curve（AUC）on vulnerable plaque,ACI and TIA were 0.87,0.61 and 0.57.Conclusion The level of serum PAPP-A can be treated as a prediction index of carotid atherosclerotic vulnerable plaque,and the growing of which may be a risk factor of ICVD.