急性缺血性脑血管病患者血清ox-LDL及PAPP-A水平与颈动脉粥样硬化的相关性研究

Correlationships of ox-LDL and PAPP-A serum levels with carotid atherosclerosis in patients with acute ischemic cerebral vascular diseases

目的探讨急性缺血性脑血管病患者颈动脉粥样硬化与血清氧化型低密度脂蛋白（ox-LDL）、妊娠相关血浆蛋白A（PAPP-A）水平的关系。方法随机选取急性脑梗死患者90例和短暂性脑缺血发作（TIA）患者60例作为研究对象,随机选取健康体检者30例作为对照组。入选者均检测血清ox-LDL、PAPP-A水平。对急性脑梗死和TIA患者进行颈动脉超声检查,发现颈动脉内-中膜厚度（IMT）正常者22例,IMT增厚者47例,颈动脉斑块形成者81例,其中稳定斑块者49例,不稳定斑块者32例。比较各组血清ox-LDL及PAPP-A水平。结果急性脑梗死组血清PAPP-A及ox-LDL水平显著高于TIA组（P〈0.01）,后者显著高于正常对照组（P〈0.01）;在缺血性脑血管病患者中,颈动脉粥样硬化斑块形成者血清PAPP-A及ox-LDL水平较颈动脉IMT增厚组明显升高（P〈0.01）,后者高于IMT正常组（P〈0.01）;在颈动脉斑块形成者中,其血清PAPP-A及ox-LDL水平在不稳定斑块组高于稳定斑块组（P〈0.01）。Spearman分析显示,血清PAPP-A与ox-LDL水平之间存在明显相关性（r=0.839,P〈0.05）;logistic回归分析显示,血清PAPP-A与ox-LDL水平是发生颈动脉粥样硬化的危险因素（OR=2.549,95%CI1.12~3.79;OR=1.317,95%CI1.15~2.11）。结论急性缺血性脑血管病患者颈动脉粥样硬化的发生和进展与ox-LDL、PAPP-A水平相关,血清ox-LDL及PAPP-A水平可在一定程度上反映急性缺血性脑血管病患者颈动脉粥样硬化的程度。两者在颈动脉甚至颅内动脉粥样硬化的形成过程中产生协同作用。

Objective To explore the correlationrelationships of serum levels of ox-LDL and PAPP-A with carotid atheroselerosis in patients with acute ischemic cerebral vascular diseases. Methods 90 patients with acute cerebral infarc- tion and 60 patients with TIA and 30 normal controls were chosen in this research. The levels of serum ox-LDL and PAPP- A were measured with the method of enzyme linked immunosorbent assay. All the patients with acute ischemic cerebral vas- cular diseases were divided into normal intima media thickness （ IMT ） group （ 22 cases ） , intima media thickened group （47 cases）, plaque group （81 cases ） according to their results of carotid artery sonography. Among the 81 patients of plaque group, there were 49 cases with stable plaque and 32 cases with unstable plaque. The leveis of ox-LDL and PAPP-A in serum were determined and compared among the different groups. Results Serum levels of ox-LDL and PAPP-A in pa- tients with acute cerebral infarction were significantly higher than those of patients with TIA （ P 〈 0. O1 ）. The latter were significantly higher than those of normal control subjects （P 〈 0.01 ）. Among patients with acute ischerhic cerebral vascular diseases, the levels of ox-LDL and PAPP-A in serum of patients in plaque were significantly increased compared with those of patients in intima media thickened group （P 〈 0.01 ）. The latter were higher than those of patients in normal intima media thickness group （P 〈 0.01 ）. The levels of ox-LDL and PAPP-A in serum of patients with unstable plaque were sig- nificantly increased than those of stable plaque group （ P 〈 0.01 ）. Spearman analysis showed that levels of ox-LDL in ser- um were correlated with those of PAPP-A （ r = 0. 839, P 〈 0.05 ）. Logistic regression showed that serum levels of ox-LDL and PAPP-A were the risk factors of recurrence of carotid artery atherosclerosis（ OR = 2. 549,95% CI 1.12 - 3.79 ; OR = 1. 317,95% CI1.15 - 2.11 ）. Conclusion The levels of ox-LDL and PAPP-A in serum are related to the occurrence and progression of carotid artery atherosclerosis among the patients with acute cerebral infarction and TIA. The levels of ox-LDL and PAPP-A in serum may reflect the degree of carotid artery atherosclerosis among the patients with acute isehemic cere- bral vascular diseases. There may be a cooperative action in ox-LDL and PAPP-A during the process of carotid artery ather- osclerosis.