血浆Lp-PLA2与高分辨率磁共振评估的大脑中动脉斑块特征的相关性研究

Correlation between the level of plasma Lp-PLA2 and the characteristics of middle cerebral artery plaque assessed by high resolution magnetic resonance imaging

目的应用高分辨率磁共振(HRMRI)初步研究血浆脂蛋白相关磷脂酶A2(Lp-PLA2)与大脑中动脉(MCA)斑块特征的关系。方法收集大脑中动脉M1段狭窄的缺血性脑血管病患者99例。对MCA狭窄段进行HRMRI检查,评估斑块特征,分为不稳定斑块组(47例)和稳定斑块组(52例)。检测所有患者血浆Lp-PLA2水平。结果①不稳定斑块组Lp-PLA2水平显著高于稳定斑块组(P<0.05);②高水平Lp-PLA2组中出现斑块内出血、强化斑块、混合斑块的例数较正常Lp-PLA2组高(P<0.05);③Lp-PLA2是MCA不稳定斑块的独立危险因素(P<0.05);④Lp-PLA2水平预测斑块稳定性的ROC曲线下面积为0.764(95%CI:0.669-0.859,P<0.05)其界限值为180.115ng·mL^(-1),敏感度81%,特异度75%。结论Lp-PLA2与HRMRI评估的颅内不稳定斑块相关,是颅内不稳定斑块的危险因素。血浆Lp-PLA2与HRMRI联合,为早期发现颅内不稳定斑块提供更准确的检测手段。

Objective To initially explore the relationship between the level of plasma Lp-PLA2 and the characteristics of middle cerebral artery(MCA)assessed by high resolution magnetic resonance imaging(HRMRI).Methods A total of 99 patients with ischemic cerebrovascular disease were collected who had MCA-M1 segment stenosis.MCA-M1 plaques were examined with HRMRI to assess the signal characteristics.According to the characteristics of plaques,they were divided into unstable plaque group(47cases)and stable plaque group(52 cases).Lp-PLA2 level was tested.Results The Lp-PLA2 level in the unstable plaque group was higher than that in the stable plaque group,there was a significant difference between them(P<0.05);Compared to the normal Lp-PLA2,the cases of intraplaque hemorrhage,enhanced plaque and mixed plaque in the high level Lp-PLA2 group was higher,the difference was statistically significant(P<0.05),Lp-PLA2 was an independent risk factor for MCA unstable plaque(P<0.05).The area under the ROC curve of Lp-PLA2 which predicted plaque stability was 0.764(95%CI:0.669-0.859,P<0.05),the diagnostic value of 180.115ng·mL^(-1),the sensitivity of 81%,the specificity of 75%.Conclusions Lp-PLA2 is associated with intracranial unstable plaque evaluated by HRMRI and is a risk factor for intracranial unstable plaque.The combination of plasma Lp-PLA2 and HRMRI provides a more accurate test for early detection of intracranial unstable plaque.