血清胎球蛋白A、肿瘤坏死因子-α和白介素-1β联合诊断急性脑梗死患者颈动脉易损斑块的价值

Diagnostic value of serum alpha2-heremans-schmid glycoprotein combined with tumor necrosis factor-α and interleukin-1β in detecting carotid vulnerable plaque in patients with acute cerebral infarction

目的研究血清胎球蛋白A(AHSG)、肿瘤坏死因子-α(TNF-α)和白介素-1β(IL-1β)联合诊断急性脑梗死(ACI)患者颈动脉易损斑块的价值。方法纳入ACI患者136例,依据颈动脉超声结果分为稳定斑块组57例和易损斑块组79例,收集临床资料。应用Logisitc回归模型,分析ACI患者颈动脉易损斑块的独立危险因素;采用受试者工作特征(ROC)曲线,探索血清AHSG、TNF-α、IL-1β各自及联合对ACI患者颈动脉易损斑块的诊断效能。结果 (1)易损斑块组ACI患者AHSG水平显著低于稳定斑块组(P <0.05),而TNF-α、IL-1β水平显著高于稳定斑块组(P <0.05)。(2)高血压病(OR=1.257,95%CI:1.017～1.554)、2型糖尿病(OR=1.474,95%CI:1.048～2.074)、LDL(OR=1.226,95%CI:1.032～1.457)、AHSG(OR=0.510,95%CI:0.287～0.920)、TNF-α(OR=1.020,95%CI:1.006～1.029)及IL-1β(OR=1.484,95%CI:1.067～2.062)为颈动脉易损斑块的独立影响因素。(3)血清AHSG、TNF-α、IL-1β联合诊断颈动脉易损斑块的曲线下面积(AUC)为0.903(95%CI:0.840～0.947),敏感度为89.87%,特异度为75.44%,显著优于3个指标单独的诊断效能(P <0.05)。结论血清AHSG、TNF-α、IL-1β是ACI患者颈动脉易损斑块的独立影响因素,均可作为早期辅助诊断颈动脉易损斑块的指标,且三者联合诊断效能最佳,临床应用价值高。

Objective To investigate the role of the combination of alpha2-heremans-schmid glycoprotein (AHSG),tumor necrosis factor-α(TNF-α),and interleukin-1β(IL-1β)in detecting carotid vulnerable plaque in patients with acute cerebral infarction(ACI). Methods A total of 136 ACI patients were enrolled. According to the carotid ultrasound results,patients were assigned into the stable plaque group(n = 57)and vulnerable plaque group(n = 79). And their clinical data were collected. Logistic regression analyses were performed to identify independent risk factors of carotid vulnerable plaque in ACI patients. Receiver operating characteristic(ROC) was used to explore the diagnostic efficacy of AHSG,TNF-α,IL-1β and their combination in detecting carotid vulnerable plaque. Results (1)AHSG level of vulnerable plaque group was significantly lower than that of stable plaque group(P < 0.05),while the levels of TNF-α and IL-1β of vulnerable plaque group were higher than those of stable plaque group.(2)Multivariate logistic regression analyses revealed that hypertension(OR = 1.257,95% CI:1.017 ~ 1.554),type 2 diabetes(OR = 1.474,95%CI:1.048 ~ 2.074),AHSG(OR = 0.510,95%CI: 0.287 ~ 0.920),TNF-α(OR = 1.020,95%CI:1.006 ~ 1.029)and IL-1β(OR = 1.484,95%CI:1.067 ~ 2.062) were independent risk factors of carotid vulnerable plaque.(3)ROC curves revealed that the area under the curve (AUC)of AHSG combined with TNF-α and IL-1β detecting carotid vulnerable plaque was 0.903(95%CI:0.840 ~ 0.947),with sensitivity of 89.87% and specificity of 75.44%,which was significantly superior to that of three individual biomarker(P < 0.05). Conclusions AHSG,TNF-α and IL-1β are independent risk factors of carotid vulnerable plaque in ACI patients,and their combination has the highest predictive efficacy which is of high clinical significance.