血清五聚素3、超敏C反应蛋白、脂蛋白相关磷脂酶A2水平以及微栓子信号与大动脉粥样硬化型急性脑梗死患者颈动脉粥样硬化斑块稳定性的相关研究

Study of association among the serum levels of pentraxin 3,hypersensitive C-reactive protein,lipoprotein associated phospholipase A2,microembolic signals and the stability of carotid artery plaque in patients with acute cerebral infarction due to large-art

目的探讨血清五聚素3(PTX3)、超敏C反应蛋白(hs-CRP)、脂蛋白相关磷脂酶A2(LpPLA2)水平以及微栓子信号(MES)与大动脉粥样硬化型急性脑梗死患者颈动脉粥样硬化斑块稳定性的关系。方法依据中国缺血性卒中亚型分型(CISS),选取起病72 h内大动脉粥样硬化型急性脑梗死患者78例,使用二维彩色多普勒超声检测仪对颈动脉斑块的解剖和病理类型进行分析,将患者分为不稳定斑块组(40例)和稳定斑块组(38例),并同期从体检中心选取健康成人30名作为对照组。测定所有观察对象血清PTX3、hsCRP以及Lp-PLA2水平,分析各组间三种血液学指标水平的差异,并分别对三种血液学指标水平与颈动脉斑块稳定性进行相关性分析。对不稳定斑块组和稳定斑块组患者行TCD监测,分析两组之间MES检出率的差异。结果不稳定斑块组及稳定斑块组血清Hcy、hs-CRP、PTX3、Lp-PLA2水平及高血压的比例均明显高于对照组(均P<0.05);不稳定斑块组他汀类用药史的比例明显高于对照组,血清PTX3、Lp-PLA2水平明显高于稳定斑块组(均P<0.05)。不稳定斑块组的MES检出率显著高于稳定斑块组(P<0.05)。Logistic回归分析显示,血清PTX3、Lp-PLA2水平是与斑块稳定性密切相关的影响因素(均P<0.05)。血清PTX3水平预测斑块稳定性的ROC曲线下面积为0.963(P<0.05),其临界值为2.57 ng/m L时,灵敏度为78.9%,特异度为84.2%。血清Lp-PLA2水平预测斑块稳定性的ROC曲线下面积为0.927(P<0.05),其临界值为54.35μg/L时,灵敏度为72.9%,特异度为81.6%。结论血清PTX3、Lp-PLA2水平可能是预测颈动脉斑块稳定性的生物学指标。MES监测对于颈动脉斑块的稳定性评估具有一定的临床意义。

Objective To study the association among the serum levels of pentraxin 3（ PTX3）,hypersensitive C-reactive protein（ hs-CRP）,lipoprotein associated phospholipase A2（ Lp-PLA2）,microembolic signals（ MES）and the stability of carotid artery plaque in patients with acute cerebral infarction due to large-artery atheroslerosis.Methods According to Chinese ischemic stroke subclassification（ CISS）,seventy-eight patients with acute cerebral infarction of large-artery atheroslerosis type within 72 h after onset were included into analysis. These patients were divided into unstable plaque group（ 40 cases） and stable plaque group（ 38 cases） based on the anatomy and pathological results of carotid artery color doppler ultrasound. Thirty healthy volunteers selected from medical center as control group. The plasma PTX3,hs-CRP and Lp-PLA2 level were detected with double antibody ELISA in all groups and compare them among different groups. The relationship between the hematology index and the stability of carotid artery plaque was analyzed. The cerebral artery MES of patients were detected by color transcranial Doppler and compare the results between stable group and unstable group. Results Compared with the control group,the plasma PTX3,Lp-PLA2 levels and the proportion of hypertension were significant higher in acute cerebral infarction patients（ all P〈0. 05）. Compared with the stable plaque group,the proportion of patients who took stains were significant higher in the unstable group. The PTX3,Lp-PLA2 levels were also significant higher in unstable group（ all P〈0. 05）. MES of unstable plaque group were significant higher than stable group（ P〈0. 05）. Multivariable logistic regression revealed that plasma PTX3 and Lp-PLA2 levels were significantly associated with unstable carotid plaque（ all P〈0. 05）. The area under the ROC curve for serum PTX3 and Lp-PLA2 to predict the stability of plaque was 0. 963 and 0. 927,respectively（ all P〈0. 05）. The sensitivity and specificity were 78. 9% and 84. 2% with a cutoff value 2. 57 ng / m L of PTX3 and 72. 9% and 81. 6% with a cutoff value 54. 35 μg / L of Lp-PLA2. Conclusions Plasma PTX3 and Lp-PLA2 maybe the useful biomarker to predict the unstable carotid plaques. MES monitoring is valuable for assess the stability of carotid artery plaque.