Lp-PLA2联合hs-CRP对急性缺血性脑卒中患者TOAST分型的鉴别价值

Evaluation of the combination of the Lp-PLA2 and hs-CRP levels for differential diagnosis of TOAST in patients with acute ischemic stroke

目的探讨脂蛋白相关磷脂酶A2(Lp-PLA2)联合超敏C反应蛋A(hs-CRP)对急性缺血性脑卒中(ACIS)患者急性缺血性脑卒中试验(TOAST)病因分型的临床鉴别意义。方法选取2018年1月至2018年10月徐州医科大学附属医院神经内科收治入院的241例ACIS患者作为观察组,同期徐州医科大学附属医院85例健康体检者作为对照组,分析2组间一般资料和生化指标的差异。依据Lp-PLA2和hs-CRP水平将观察组患者分为4组:Lp-PLA2-/hs-CRP-、Lp-PLA2+/hs-CRP-、Lp-PLA2-/hs-CRP+、Lp-PLA2+/hs-CRP+,比较TOAST各亚型4个分组所占比例的差异。结果2组高血压比例的差异有统计学意义(P<0.05);观察组甘油三酯(TG)Lp-PLA2、hs-CRP水平明显高于对照组,差异有统计学意义(P<0.05)。Logistic回归分析显示Lp-PLA2和hs-CRP是ACIS的危险因素(P<0.05).Pearson相关性分析提示Lp-PLA2和hs-CRP呈正相关(P<0.01)。LAA型患者Lp-PLA2+/hs-CRP+组所占比例明显高于其他3组,且明显高于CE、SAO、SOE和SUE型患者Lp-PLA2+/hs-CRP+组所占比例。结论血清中Lp-PLA2和hs-CRP水平均升高是LAA型ACIS患者发病的高危因素,二者联合检测可为LAA型ACIS患者的早期诊断提供更有力的依据。

Objective To investigate the clinical significance of lipoprotein - associated phospholipase A2 ( Lp - PLA2) combined with high sensitivity C - reactive protein ( hs - CRP) in the etiological classification of TOAST (Trial of Org 10172 in Acute Stroke Treatment) in patients with acute ischemic stroke. Methods A total of 241 patients (observation group) with acute cerebral ischemic stroke ( ACIS) were selected from the Department of Neurology, the Affiliated Hospital of Xuzhou Medical University from January 2018 to October 2018 and 85 healthy subjects ( control group) who underwent physical examination in the Affiliated Hospital of Xuzhou Medical University at the same period. The general information and biochemical indicators between the observation group and control group were compared. According to the levels of Lp - PLA2 and hs 一 CRP, the patients in the observation group were divided into four groups: Lp - PLA2 -/hs -CRP -, Lp- PLA2 +/hs - CRP -, Lp - PLA2 -/hs 一 CRP + and Lp - PLA2 +/hs - CRP +. The differences of positive rate of TOAST among the two groups were compared. Results There was a significant difference in the proportion of hypertension between the two groups ( P <0. 05). The levels of triglyceride (TG), Lp - PLA2 and hs - CRP in the observation group were significantly higher than those in the control group ( P < 0. 05 ). Logistic regression analysis showed that there were significant differences in Lp 一 PLA2 and hs - CRP ( P < 0. 05 ). Pearson correlation analysis showed that Lp - PLA2 and hs - CRP were positively correlated ( P < 0. 01 ). The positive rate of large - artery artherosclerosis (LAA) patients in Lp - PLA2 +/hs - CRP + group was significantly higher than that in Lp - PLA2 -/hs - CRP - group,Lp - PLA2 +/hs - CRP - group and Lp - PLA2 -/hs - CRP + group ( P < 0. 05 ), and significantly higher than that of cardioeniholism ( CE) patients, small artery occlusion ( SAO) patients, stroke of oilier detrnnined etiology (SOE) patients and stroke of undetermined etiology ( SUE) patients in Lp - PLA2 +/hs - CRP + group ( P < 0. 05). Conclusions The elevated levels of Lp - PLA2 and hs - CRP are the high risk factors in ACIS ( LAA) patients. The combination detection of Lp - PLA2 and hs - CRP can provide a more powerful convenience for the early diagnosis of LAA patients in ACIS patients than the single detection.