急性缺血性脑卒中患者血清氧化型低密度脂蛋白水平与颈动脉易损斑块的关系

Relationship Between Serum Oxidized Low-density Lipoprotein Level and Carotid Vulnerable Plaque in Patients with Acute Cerebral Ischemic Stroke

目的探讨急性缺血性脑卒中患者血清氧化型低密度脂蛋白（ox-LDL）水平与颈动脉易损斑块的关系,评估ox-LDL对易损性颈动脉斑块的识别能力,为早期识别易损性颈动脉斑块探索新的途径。资料与方法选择经CT和MRI确诊为急性缺血性脑卒中的181例患者,根据颈动脉超声检查将其分为无斑块组48例、稳定斑块组38例、易损斑块组95例。检测血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹血糖及血清ox-LDL水平,并采用双功能彩色多普勒超声检测颈动脉内膜中层厚度（IMT）、总斑块面积（TPA）及斑块性质,分析血清ox-LDL与缺血性脑卒中危险因素的相关性。结果斑块组合并高血压、血清ox-LDL明显高于无斑块组（P〈0.05）;易损斑块组血清ox-LDL、TPA明显高于稳定斑块组（P〈0.01）。血清ox-LDL水平与颈动脉IMT、总胆固醇、LDL-C呈正相关（r1=0.154,P〈0.05;r2=0.338,P〈0.05;r3=0.385,P〈0.05）;Logistic回归分析结果显示,血清ox-LDL是急性缺血性脑卒中患者颈动脉易损斑块形成的独立危险因素（OR=1.038,95%CI 1.008-1.069,P〈0.01）。结论急性缺血性脑卒中患者血清ox-LDL与颈动脉易损斑块的形成独立相关,ox-LDL可以作为临床筛查易损斑块的血清学指标,颈动脉超声联合应用血清学检查可以早期识别可能导致脑缺血事件发生的颈动脉易损斑块。

Purpose To investigate the relationship between the serum oxidized lowdensity lipoprotein（ox-LDL） level and carotid vulnerable plaque in patients with acute cerebral ischemic stroke,and to evaluate the ability of serum ox-LDL in identifying vulnerable carotid plaques. Materials and Methods 181 patients with history of acute cerebral ischemic stroke were recruited. According to the results of carotid ultrasound patients were divided into non plaque group（n=48）,stable plaque group（n=38） and vulnerable plaque group（n=95）. The serum total cholesterol,triglyceride,high density lipoprotein-cholesterol,low density lipoprotein-cholesterol,fasting plasma glucose and ox-LDL were measured. Carotid intima-medial thickness（CIMT）,total carotid plaque area（TPA） and the characters of plaque were examined with color Doppler ultrasound. Results The serum ox-LDL and the number of patients with hypertension in plaque group were significantly higher than that in the non-plaque group（P〈0.05）. The serum ox-LDL and TPA in the vulnerable plaque group were significantly higher than that in the stable plaque group（P〈0.05）. Serum ox-LDL in patients with acute cerebral infarction was positively correlated with CIMT,serum total cholesterol and LDL-C（r1=0.154,P〈0.05; r2=0.338,P〈0.05; r3=0.385,P〈0.05）. Logistic regression analysis showed that serum ox-LDL was an independent risk factor for carotid vulnerable plaque（OR=1.038,95% CI 1.008-1.069,P〈0.01）. Conclusion The serum ox-LDL is independently associated with the formation of vulnerable plaque in patients with acute cerebral infarction. This study suggests that ox-LDL can be used as a biomarker in screening for vulnerable carotid plaque in clinical practice. Carotid ultrasound combined with serology can early identify carotid artery vulnerable plaque that may lead to cerebral ischemic events.