Lp-PLA2表达差异程度是否可作为脑卒中患者颈动脉内膜剥脱术围手术期风险的标志物评估

Evaluation of whether the degree of Lp-PLA2 expression differences can be used as the biomarker for predicting the perioperative risks during CEA for cerebral apoplexy patients

目的分析脑卒中患者颈动脉内膜剥脱术(CEA)前后血浆Lp-PLA2水平变化,并评估Lp-PLA2表达差异程度与围手术期并发症风险的关系。方法选取CEA治疗的脑卒中患者44例,检测术前1周和术后4周Lp-PLA2蛋白的表达水平,并进行2a随访,统计围手术期并发症和脑卒中、血管再狭窄等复发情况。结果对缺血性脑卒中的相关危险因素进行Logistic回归分析,结果显示,以缺血性脑卒中是否发病为应变量,相关危险因素,如年龄、性别、吸烟史、高血压、糖尿病、Lp-PLA2为自变量,得到多元回归方程:缺血性脑卒中=-2.361+0.796吸烟+0.005Lp-PLA2。由此得出,Lp-PLA2是缺血性脑卒中的危险因素(P<0.05)。术前1周和术后4周Lp-PLA2蛋白表达水平显示,其中表达差异大31例,表达差异小13例,并进行2a随访。最终发现,表达差异程度大患者出现脑卒中(P<0.05)和再狭窄(P<0.05)的几率明显降低。结论 Lp-PLA2是缺血性脑卒中的独立预测因子,且Lp-PLA2表达水平差异可作为脑卒中患者开展CEA围手术期风险预测标志物。

Objective To analyze the Lp-PLA2 expression difference before and after carotid endarterectomy（CEA） ,and evaluate the association between the degree of expression differences and risk of perioperative complications. Methods These patients who were diagnosed as cerebral apoplexy and adopted CEA surgery, were enrolled in the present cohort. The Lp-PLA2 expression was examined one week before and four weeks after surgery. In addition,the two years follow-up was also conduc- ted ,and the complications during perioperative period, cerebral apoplexy and vascular restenosis during the two years follow-up were also recorded. Results A total of 44 patients were enrolled,and the Logistic regression test was performed,by which the cerebral arterial thrombosis was treated as dependent variant and the related risk factors, such as age, sex, smoking status, hy- pertension,diabetes and Lp-PLA2 were regarded as independent variable, the multiple regression equation was demonstrated as ： cerebral arterial thrombosis = - 2.361 ＋ 0. 796 smoking status ＋ 0. 005 Lp-PLA2. Therefore, we can conclude that the Lp- PLA2 was a risk factor for cerebral arterial thrombosis（P〈0.05）. In addition, we also recorded the Lp-PLA2 expression levels one week before surgery and four weeks after surgery,and identified that a total of 31 cases were of high variability, while 13 cases were of lower variability. After two years＇ follow-up, we revealed that these patients with high variability of Lp-PLA2 expression were of significant lower risk to get cerebral apoplexy and restenosis（P〈0.05）. Conclusion Lp-PLA2 is an inde- pendent risk factor for cerebral arterial thrombosis,and the degree of expression differences can be used to predict the risk of perioperative risk during CEA.