颈动脉斑块内新生血管显影程度及血浆Lp-PLA2水平对急性脑梗死的临床诊断价值

Diagnostic value of the level of plasma lipoprotein-associated phospholipase A2 and the CEU degree of neovascularization of carotid artery plaque in acute cerebral infarction

目的探讨颈动脉斑块内新生血管显影程度及血浆Lp-PLA2水平对急性脑梗死(ACI)的临床诊断价值。方法选取44例ACI患者(ACI组)和41例体检者(非ACI组),分别进行超声造影,观察斑块内新生血管显影强度并进行分级。采用双抗体夹心免疫层析法检测两组血浆Lp-PLA2水平。结果 ACI组与非ACI组颈动脉斑块内新生血管显影分级差异有统计学意义(Z=-5.29,P<0.001),ACI组新生血管显影分级以Ⅲ、Ⅳ级为主,中位等级为Ⅲ级;非ACI组则以Ⅰ、Ⅱ级为主,中位等级为Ⅱ级;ACI组血浆Lp-PLA2水平高于非ACI组(t=6.64,P<0.001),以199.76μg/L为截断值,诊断ACI的灵敏度84.10%,特异性68.30%,曲线下面积0.84。斑块内新生血管显影分级越高的患者,其血浆Lp-PLA2水平越高,两者呈正相关(rs=0.60,P<0.01)。结论超声造影作为一种无创性的检查可以实时观察颈动脉斑块内的新生血管,并作出定量分析;颈动脉斑块内新生血管的显影级别高与血浆Lp-PLA2水平升高可能对ACI的临床诊断有价值。

Objective To detect the value of plasma lipoprotein-associated phospholipase A2（Lp-PLA2） and the contrast-enhanced untrasonography（CEU） degree of neovascularization of carotid artery plaque in diagnosis of acute cerebral infarction（ACI）.Methods A total of 44 patients with ACI（ACI group） and 41 patients without ACI（non-ACI group） were selected.The enrolled patients underwent conventional and CEU.The development intensity of neovascularization was observed and classified.The plasma Lp-PLA2 levels were detected by double antibody sandwich immunochromatography assay.Results There was significant difference between ACI group and non-ACI group in the grade of neovascularization of carotid plaques（Z=-5.29,P〈0.01）.The grade of neovascularization in ACI group was mostlyⅢ and Ⅳ（median Ⅲ） and that of non-ACI group was mostlyⅠandⅡ（medianⅡ）.The plasma Lp-PLA2 levels in ACI group were significantly higher than those in non ACI group（t=6.64,P〈0.001）.With cutoff value 199.76 μg/L,the sensitivity,specificity,and area under the curve（AUC） were 84%,68%,and 0.84,respectively.The higher the grade of neovascularization of carotid plaque,the higher the levels of plasma Lp-PLA2（rs=0.60,P〈0.001）,and therewas a positive correlation between them.Conclusion As a noninvasive method,CEU can be used to observe neovascularization of carotid plaque in real time,and make a quantitative analysis.The higher grade of neovascularization of carotid plaque and the higher levels of the plasma Lp-PLA2 may be valuable for clinical diagnosis of ACI.