HR-MRI血管壁成像技术联合血清ox-LDL、Lp-PLA2水平对大脑中动脉粥样硬化性狭窄患者预后的评估价值

The prognostic value of HR-MRI vascular wall imaging combined with serum ox-LDL and Lp-PLA2 levels in patients with middle cerebral atherosclerotic stenosis

目的评估高分辨率核磁共振成像(HR-MRI)血管壁成像技术联合血清氧化型低密度脂蛋白(ox-LDL)、脂蛋白相关磷脂酶A2(Lp-PLA2)水平对大脑中动脉粥样硬化性狭窄(MCAS)患者预后的诊断价值。方法选取2015年8月—2017年8月经神经内科明确诊断为脑梗死,并通过经颅多普勒超声(TCD)、磁共振成像(MRI)、磁共振血管成像(MRA)以及临床表现确诊为MCAS的患者106例(狭窄组);另选取90例同期入院体检正常者作为对照组。HR-MRI血管壁成像技术获取患者斑块大小、斑块负荷参数。酶联免疫吸附法(ELISA)检测受试者血清中ox-LDL、Lp-PLA2水平。治疗3个月后采用改良Rankin量表(mRS)评定预后情况(mRS评分>2分为预后不良),分为预后不良组85例和预后良好组21例。Pearson法分析斑块大小、斑块负荷及血清中ox-LDL、Lp-PLA2水平与mRS评分的相关性。受试者工作特征(ROC)曲线分析HR-MRI血管壁成像技术联合血清ox-LDL、Lp-PLA2水平对MCAS患者预后的诊断效能。结果与对照组相比,狭窄组斑块大小、斑块负荷、血清ox-LDL和Lp-PLA2水平明显增加(P<0.05)。与预后良好组相比,预后不良组患者斑块大小、斑块负荷、血清ox-LDL和Lp-PLA2水平均显著增加(P<0.05)。斑块大小、斑块负荷、血清ox-LDL和Lp-PLA2水平与mRS评分均呈正相关(r=0.695、0.664、0.667、0.679,P<0.05),且均有较高诊断效能,联合检测预测MCAS患者预后的诊断效能更高。结论斑块大小、斑块负荷、血清ox-LDL和Lp-PLA2水平对MCAS患者预后均有较高诊断效能,联合检测诊断效能更高,HR-MRI血管壁成像技术联合血清ox-LDL、Lp-PLA2水平对临床诊断MCAS患者预后有一定参考价值。

Aim To evaluate the diagnostic value of high resolution nuclear magnetic resonance imaging(HR-MRI),oxidized low density lipoprotein(ox-LDL)and lipoprotein associated phospholipase A2(Lp-PLA2)in serum for the prognosis of patients with middle cerebral atherosclerotic stenosis(MCAS).Methods From August 2015 to August 2017,106 patients(stenosis group)who were diagnosed as cerebral infarction by neurology department,and diagnosed as MCAS by transcranial Doppler(TCD),magnetic resonance imaging(MRI),magnetic resonance angiography(MRA)and clinical manifestations were selected,and another 90 patients with normal physical examination were selected as control group.The parameters of plaque size and plaque load were obtained by HR-MRI vascular wall imaging technology.Enzyme linked immunosorbent assay(ELISA)was used to detect the levels of ox-LDL and Lp-PLA2 in serum.After 3 months of treatment,the prognosis was assessed by modified Rankin Scale(mRS scores>2 was poor prognosis),and the patients were divided into 85 cases of poor prognosis group and 21 cases of good prognosis group.Pearson method was used to analyze the correlation between plaque size,plaque load,levels of ox-LDL and Lp-PLA2 in serum and mRS scores.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic effect of HR-MRI combined with serum ox-LDL and Lp-PLA2 on the prognosis of patients with MCAS.Results Compared with the control group,the plaque size,plaque load,serum ox-LDL and Lp-PLA2 levels in the stenosis group were significantly increased(P<0.05).Compared with the good prognosis group,the plaque size,plaque load,serum ox-LDL and Lp-PLA2 levels in the poor prognosis group were significantly increased(P<0.05).Plaque size,plaque load,serum ox-LDL and Lp-PLA2 levels were all positively correlated with mRS scores(r=0.695,0.664,0.667,0.679,P<0.05),and have high diagnostic efficiency,the combined detection was more effective in predicting the prognosis of patients with MCAS.Conclusion Plaque size,plaque load,serum ox-LDL and Lp-PLA2 levels have high diagnostic efficacy for the prognosis of MCAS patients,and the diagnostic efficacy of combined detection is higher,HR-MRI vascular wall imaging combined with serum ox-LDL and Lp-PLA2 levels has certain reference value for clinical diagnosis of MCAS patients.