载脂蛋白和同型半胱氨酸水平与颈动脉粥样斑块稳定性及狭窄程度的相关性研究

Study on the Correlation between apolipoprotein and homocysteine levels with carotid atherosclerotic plaque stability and degree of stenosis

目的探讨载脂蛋白和同型半胱氨酸水平与颈动脉斑块稳定性及狭窄程度的相关性。方法连续收集哈尔滨市第四医院2017年1月至2017年12月就诊的100例老年急性脑梗死患者,所有患者均行颈动脉彩超检查,根据彩超结果分为稳定斑块组和不稳定斑块组,根据血管狭窄程度分为动脉内膜增厚组23例、轻度狭窄组(狭窄程度<50%)26例,中度狭窄组(狭窄程度≥50%~<70%)28例,重度狭窄组(狭窄程度≥70%)[1]23例。所有入选患者于清晨空腹抽取肘静脉血,检测载脂蛋白(Apolipoprotein,ApoB)和同型半胱氨酸(Homocysteine,Hcy)浓度。结果稳定斑块组和不稳定斑块组比较,吸烟、饮酒、糖化血红蛋白(Hemoglobin A1c,HbA1c)、ApoB、Hcy组间差异均有统计学意义(P均<0.05),性别、糖尿病病史、高血压病史、收缩压、舒张压、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)组间比较差异均无统计学意义(P均>0.05)。在对除外血脂的相关危险因素校正后,做颈动脉狭窄多因素条件logistic分析:结果表明,经校正后,饮酒[OR=1.247(95%CI:0.626~1.958),P=0.043]、Hcy[OR=3.163(95%CI:1.824~4.772),P=0.045]、收缩压[OR=1.286(95%CI:0.688~2.005),P=0.027]、HbA1c[OR=3.671(95%CI:1.904~6.630),P=0.011]、ApoB[OR=1.717(95%CI:1.005~2.634),P=0.036]、LDL-C[OR=1.516(95%CI:0.968~2.489),P=0.024]、TC[OR=1.403(95%CI:0.801~2.343),P=0.030]和TG[OR=1.342(95%CI:0.712~2.198),P=0.019]都是颈动脉不稳定斑块及颈动脉严重狭窄程度发生的独立危险因素。结论载脂蛋白和同型半胱氨酸可能是预测颈动脉不稳定斑块及颈动脉严重狭窄程度的独立预测指标。

Objective To investigate the correlation between apolipoprotein and homocysteine levels with the stability of carotid plaque and the degree of stenosis.Methods One hundred elderly patients with acute cerebral infarction from January 2017 to December 2017 were collected continuously in Harbin Fourth Hospital,All patients underwent color Doppler ultrasound examination of carotid artery.They were divided into stable plaque group and unstable plaque group according to the results of color Doppler ultrasound,then according to the degree of stenosis they were divided into intimal thickening group with 23 cases,mild stenosis(stenosis degree<50%)with 26 cases,moderate stenosis group(50%≤stenosis degree<70%)with 28 cases,severe stenosis group(70%≤stenosis degree)with 23 cases.All the patients were selected to collect the blood of the elbow in the early morning to detect the level of apolipoprotein B and Hcy.Results Compared with unstable plaque group,smoking,drinking,hemoglobin A1c(HbA1c),ApoB and Hcy had significant differences(all P<0.05).Gender,history of diabetes mellitus,history of hypertension,systolic pressure,diastolic pressure,low density lipoprotein cholesterol(LDL-C),triglyceride(TG)There was no significant difference in total cholesterol(TC)and total cholesterol(all P>0.05).Multivariate logistic regression was performed after correcting the related risk factors excluding blood lipids.The results showed that alcohol(OR=1.247(95%CI:0.626-1.958),P=0.043),Hcy(OR=3.163(95%CI:1.824-4.772),P=0.045),bloodpressure(OR=1.286(95%CI:0.688-2.005),P=0.027),HbA1c(OR=3.671(95%CI:1.904-6.630),P=0.011),ApoB(OR=1.717(95%CI:1.005-2.634),P=0.036),LDL-C(OR=1.516(95%CI:0.968-2.489),P=0.024),TC(OR=1.403(95%CI:0.801-2.343),P=0.030)and TG(OR=1.342(95%CI:0.712-2.198),P=0.019)are independent risk factors for unstablecarotid plaque and severe carotid stenosis.Conclusion Apolipoprotein and homocysteine may be independent predictors of unstable carotid plaque and severity of carotid stenosis.