血浆脂蛋白相关磷脂酶A2水平与急性颈动脉硬化性脑梗死防治效果及硬化斑块稳定性的相关性研究

The correlation between plasma lipoprotein related phospholipase A2 levels and the prevention and treatment of acute carotid atherosclerotic cerebral infarction,stability of atherosclerotic plaques

目的探讨血浆脂蛋白相关磷脂酶A2水平与急性颈动脉硬化性脑梗死防治效果及硬化斑块稳定性的关系。方法收集2015年1月-2016年12月来中信惠州医院就诊的急性颈动脉硬化性脑梗死患者80例,为患病组;同期收集来本院进行体检的正常志愿者40例,为健康对照组;患病组脑梗死各时间点(入院后第1d、第2、4、8周)对患者的Lp-PLA2水平进行检测,健康对照组人群在体检时进行相同检测,对比2组间的差异。采用颈动脉超声检测患者的颈动脉硬化斑块稳定性,计算颈动脉粥样硬化斑块Crouse积分,分析Crouse积分与Lp-PLA2水平的相关性。治疗后应用NIHSS和改良Rankin量表(mRS)对治疗效果进行评估,分析其与LP-PLA2水平的关系。结果各时间点患病组患者的血浆Lp-PLA2水平均高于健康对照组(P<0.05),患病组患者从发病到缓解血浆Lp-PLA2水平逐渐改善(P<0.05);患者的Crouse积分比较,患病组中不稳定斑块组>混合斑块组>稳定斑块组>无斑块组(P<0.05);患病组中患者Lp-PLA2水平比较,不稳定斑块组>混合斑块组>稳定斑块组>无斑块组(P<0.05);Lp-PLA2水平与斑块稳定存在相关性,并与稳定斑块呈负相关(OR=-2.586,P<0.05);治疗后各时间点神经功能缺损轻型患者的Lp-PLA2水平低于中型与重型患者(P<0.05),预后良好患者的Lp-PLA2水平低于预后不良的患者(P<0.05)。结论 LpPLA2可能是颈动脉硬化性脑梗死发生的重要危险因素之一,其水平可能与动脉粥样硬化斑块的稳定性有关。

Objective To investigate the correlation between the level of plasma lipoprotein related phospholipase A2 and the prevention and treatment of acute carotid atherosclerotic cerebral infarction,the stability of atherosclerotic plaques.Methods 80 patients with acute carotid atherosclerotic cerebral infarction in CITIC Huizhou of Hospital from January 2015 to December 2016 were collected as disease group;at the same time 40 normal volunteers of physical examination in our hospital were collected as healthy control group;the LP-PLA2 levels were detected in different periods（1 day,1 week,2 weeks,4 weeks and 8 weeks）of cerebral infarction,respectively,the LP-PLA2 levels were detected in healthy controls at the same time,the differences between the two groups were compared.Carotid atherosclerotic plaques were measured by carotid ultrasound,crouse scores of carotid atherosclerotic plaques were calculated,and the correlations between crouse scores and LP-PLA2 levels were analyzed.After treatment,NIHSS and modified Rankin scale（mRS）were conducted to evaluate the therapeutic effect and the relationship between the LP-PLA2 levels and NIHSS and modified Rankin scale（mRS）were analyzed.Results The plasma Lp-PLA2 levels in different period of patients were higher than those in healthy control group,the plasma Lp-PLA2 level was gradually improved from onset to alleviate in disease group（P〈0.05）.There were obvious difference in crouse integral among the patient group,unstable plaque group,mixed plaque group,stable plaque group,the plaque group（P〈0.05）.There were obvious difference in Lp-PLA2 level among unstable plaque group,mixed plaque group,stable plaque group and non plaque group（P〈0.05）.The Lp-PLA2 level was negatively correlated with plaque stability（OR=-2.586,P〈0.05）.The Lp-PLA2 levels of light nerve function defect patients in different time point after treatment were obviously lower than those of the medium and severe patients（P〈0.05）,the LpPLA2 levels of the good prognosis patients were lower than those of the poor prognosis patients（P〈0.05）.Conclusion Lp-PLA2 might be one of the important risk factors of carotid atherosclerosis in cerebral infarction,and the Lp-PLA2 level might be related with atherosclerotic plaque stability.