脂蛋白相关磷脂酶A2、脂蛋白(a)与脑梗死进展及头颈部血管狭窄的相关性

The correlation of lipoprotein associated phospholipase A2 and lipoprotein(a) with progress of cerebral infarction and the vascular stenosis of intracranial and external

目的探讨血浆脂蛋白相关磷脂酶A2(Lp-PLA2)、脂蛋白(a)Lp(a)与大动脉粥样硬化型脑梗死急性期病情进展及头颈部血管狭窄的关系。方法收集大动脉粥样硬化型脑梗死患者117例,其中非进展性脑梗死(NPCI)67例,进展性脑梗死(PCI)50例。依据头颈部CT血管造影(CTA)、磁共振血管造影(MRA)或数字减影血管造影(DSA),将患者分为中度狭窄组48例,重度狭窄组40例,闭塞组29例。检测Lp-PLA2、Lp(a)水平,比较不同组间的差异,分析其与脑梗死进展及头颈部血管狭窄的相关性。结果PCI组性别、年龄、高血压、冠心病、吸烟、饮酒与NPCI组相比无显著差异(P>0.05),PCI组糖尿病、低密度脂蛋白胆固醇(LDLC)水平高于NPCI组(P<0.05),PCI组Lp-PLA2、Lp(a)水平显著高于NPCI组(P<0.05或P<0.01);与中度狭窄组相比,重度狭窄组和闭塞组Lp-PLA2、Lp(a)水平均显著增高(P<0.05或P<0.01);与重度狭窄组比较,闭塞组Lp-PLA2、Lp(a)水平显著增高(P<0.05)。Spearman相关分析显示,Lp-PLA2、Lp(a)与头颈部血管狭窄程度均呈正相关(P<0.05或P<0.01)。结论Lp-PLA2、Lp(a)水平与大动脉粥样硬化型脑梗死进展及头颈部血管狭窄程度密切相关。

Aim To explore the correlation between plasma lipoprotein associated phospholipase A2 ( Lp- PLA2) ,lipoprotein( a) Lp( a) and the progression of acute stage and vascular stenosis in patients with large atherosclerotic cerebral infarction. Methods 117 patients with large atherosclerotic cerebral infarction were collected,including 67 patients with non-progressive cerebral infarction ( NPCI) ,and 50 patients with progressive cerebral infarction ( PCI) . According to head and neck CT angiography ( CTA) ,magnetic resonance angiography ( MRA) or digital subtraction angiography ( DSA) ,the patients were divided into moderate stenosis group ( 48 cases) ,severe stenosis group ( 40 cases) and occlusion group ( 29 cases) . The level of Lp-PLA2 and Lp( a) were measured and the differences among different groups were compared,and the correlation with the progression of cerebral infarction and the stenosis of the vessels was analyzed. Results There was no significant difference in gender,age,hypertension,coronary heart disease,smoking and drinking between PCI group and NPCI group ( P>0.05) ,and the levels of diabetes and low density lipoprotein cholesterol ( LDLC) were higher than those in NPCI group ( P<0.05) . The levels of Lp-PLA2 and Lp( a) in PCI group were significantly higher than those in NPCI group ( P<0.05 or P<0.01) . Compared with moderate stenosis group,the levels of Lp-PLA2 and Lp( a) in severe stenosis group and occlusion group were significantly increased ( P<0.05 or P<0.01) . And compared with the severe stenosis group,the levels of Lp-PLA2 and Lp( a) in occlusion group were significantly increased ( P<0.05) . Spearman correlation analysis showed that Lp-PLA2 and Lp( a) levels were positively correlated with the degree of vascular stenosis in the head and neck ( P<0.05 or P<0.01) . Conclusion Lp-PLA2 and Lp( a) levels are closely related to the progression of cerebral infarction with large vascular atherosclerosis and the degree of vascular stenosis in the head and neck.