大动脉粥样硬化型急性脑梗死患者血清Lp-PLA2、SAA水平的变化及病情进展的影响因素分析

Changes of Serum Lp-PLA2 and SAA Levels in Patients with Atherosclerotic Acute Cerebral Infarction and Analysis of Influencing Factors for Disease Progression

目的:研究大动脉粥样硬化(LAA)型急性脑梗死(ACI)患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)、淀粉样蛋白A(SAA)水平的变化及病情进展的影响因素。方法:将我院从2017年5月2020年3月收治的81例LAA型ACI患者纳入研究,记作研究组。另取同期于我院接受体检的健康志愿者80例作为对照组。检测并比较两组血清Lp-PLA2及SAA水平,以受试者工作特征(ROC)曲线分析血清Lp-PLA2及SAA诊断LAA型ACI患者的效能。根据美国国立卫生研究院卒中量表(NIHSS)评分将患者分为进展组和非进展组,以单因素及多因素Logistic回归分析LAA型ACI患者病情进展的影响因素。结果:研究组血清Lp-PLA2及SAA水平均高于对照组,差异有统计学意义(P<0.05)。经ROC曲线分析可得:血清Lp-PLA2联合SAA诊断LAA型ACI患者的曲线下面积、敏感度、特异度、准确度均高于上述两项血清学指标单独检测。经单因素分析可得:进展组入院时收缩压、纤维蛋白原、入院时NIHSS评分、颅内外血管重度狭窄/闭塞人数占比、Lp-PLA2、SAA水平均高于非进展组(P<0.05)。经多因素Logistic回归分析可得:入院时收缩压、入院时NIHSS评分、Lp-PLA2、SAA以及颅内外血管重度狭窄/闭塞均是LAA型ACI患者病情进展的影响因素(P<0.05)。结论:LAA型ACI患者血清Lp-PLA2及SAA水平均明显升高,且LAA型ACI患者病情进展受多种因素影响,临床工作中应结合相关因素对患者进行治疗或干预,以防止病情进展。

Objective:To study the changes of serum lipoprotein-related phospholipase A2(LP-PLA2)and amyloid protein A(SAA)levels in patients with acute cerebral infarction(ACI)of large-artery atherosclerosis(LAA)type and analyze the influencing factors of the disease progression.Methods:81 patients with LAA type ACI who were admitted to the hospital from May 2017 to March2020 were included in the study group.In addition,80 healthy volunteers who underwent physical examination in the hospital during the same period were taken as the control group.Serum LP-PLA2 and SAA levels were detected and compared between the two groups,and the efficacy of serum LP-PLA2 and SAA levels in the diagnosis of LAA type ACI patients was analyzed by receiver operating characteristic(ROC)curve.Patients were divided into progress group and non-progress group according to the NATIONAL Institutes of Health Stroke Scale(NIHSS)score,and univariate and multivariate Logistic regression were used to analyze the influencing factors for the disease progression of patients with LAA type ACI.Results:The serum levels of LP-PLA2 and SAA in the study group were all higher than those in the control group,with statistically significant differences(P<0.05).ROC curve analysis showed that the area under the curve,sensitivity,specificity and accuracy of serum LP-PLA2 combined with SAA in diagnosing LAA type ACI were all higher than the above two serological indicators.The systolic blood pressure on admission,fibrinogen,NIHSS score on admission,the proportion of severe intracranial vascular stenosis/occlusion,LP-PLA2 and SAA levels in the progress group were all higher than non-progress group,and in the progress group were also higher than thoee in the non-progress group(P<0.05).Multivariate Logistic regression analysis showed that systolic blood pressure on admission,NIHSS score on admission,LP-PLA2,SAA,and severe intracranial vascular stenosis/occlusion were influencing factors for the disease progression of patients with LAA type ACI(P<0.05).Conclusion:The serum LP-PLA2 and SAA levels of patients with LAA type ACI are significantly increased,and the disease progression of patients with LAA type ACI is affected by various factors,so the patients should be treated or intervened in combination with relevant factors in clinical work to prevent the disease progression.