颈动脉彩超结合Lp-PLA2检测在动脉粥样硬化性脑梗死预测及病情评估中的临床应用

Clinical use of carotid ultrasonography and Lp-PLA2 in prediction and evaluation of atherosclerotic cerebral infarction

目的 探讨联合颈动脉彩超及人血浆脂蛋白相关磷脂酶A2（Lp-PLA2）在动脉硬化性脑梗死诊疗中的应用价值.方法 收集2015年4月至2016年6月间我院神经内科就诊的80例动脉硬化性脑梗死患者作为观察组,另选60例本院健康体检者作为对照组.采用颈动脉超声观察颈动脉内膜斑块形成情况及颈动脉内-中膜厚度（IMT）,应用发光免疫检测法检测Lp-PLA2,对比两组间颈动脉斑块检出情况、IMT及Lp-PLA2含量,并根据美国国立卫生研究院卒中量表（NIHSS）评分将观察组分为轻中重三层,对比各层IMT及Lp-PLA2含量差异,并对观察组中NIHSS评分与IMT及Lp-PLA2含量的相关性进行分析.结果 观察组颈动脉斑块检出率（85%）高于对照组（63.33%）,P〈0.05,观察组IMT及Lp-PLA2含量[（1.25＆#177;0.61）mm和（187.33＆#177;60.31）ng/ml]均高于对照组[（0.67＆#177;0.31）mm和（166.18＆#177;56.16）ng/ml],P〈0.05.观察组中以重度组IMT及Lp-PLA2含量最高,以轻度组最低（P〈0.05）.此外,观察组NIHSS评分与IMT及Lp-PLA2含量存在正向相关（r=0.857,0.672,P〈0.05）.结论 颈动脉彩超及Lp-PLA2对动脉硬化性脑梗死病情有着一定的预测价值,可用于动脉硬化性脑梗死的诊疗过程.

Objective To investigate the clinical use of carotid ultrasonography and human plasma lipoprotein associated phospholipase A2（Lp-PLA2）in the diagnosis and treatment of atherosclerotic cerebral infarction. Methods Eighty patients with atherosclerotic cerebral infarction,who were hospitalized in the Department of Neurology in our hospital between April 2015 and June 2016,were included in the study group,and 60 healthy subjects were included in the control group. The carotid ultrasonography was used to determine the formation of carotid intima plaque and carotid intima-media thickness（IMT）. The Lp-PLA2 was determined by luminescence immunoassay. The detection rate of carotid plaque,and the levels of IMT and Lp-PLA2 were compared between the two groups. According to the National Institutes of Health Stroke Scale（NIHSS）score,the study group was divided into the mild,moderate and severe sub-groups. The differences in the levels of IMT and Lp-PLA2 were compared between the sub-groups. The correlation between NIHSS score and the levels of IMT and Lp-PLA2 in the study group was analyzed. Results The detection rate of carotid plaque in the study group was higher than that in the control group（85%vs 63.33%, P〈0.05）. The levels of IMT and Lp-PLA2 in the study group were higher than those in the control group [（1.25＆#177;0.61）mm vs（0.67＆#177;0.31）mm,（187.33＆#177;60.31）ng/ml vs（166.18＆#177;56.16）ng/ml,P〈0.05]. Among the sub-groups,the levels of IMT and Lp-PLA2 were the highest in the severe group,and the lowest in the mild group（P〈0.05）. In addition,there was positive linear correlation between the NIHSS score and the levels of IMT and Lp-PLA2 in the study group （r=0.857,0.672,P〈0.05）. Conclusion The carotid ultrasonography and Lp-PLA2 show certain predictive value for atherosclerotic cerebral infarction,which can be used in the diagnosis and treatment of arteriosclerotic cerebral infarction.