脑梗死颈动脉粥样斑块与Lp-PLA2,hs-CRP的相关性及彩超的应用价值

Correlation between carotid atherosclerotic plaque and Lp-PLA2,hs-CRP in patients with cerebral infarction and the value of color doppler ultrasonography

目的探讨炎性因子脂蛋白相关磷脂酶A2(Lp-PLA2)、超敏C反应蛋白(hs-CRP)与脑梗死患者颈动脉粥样硬化程度的相关性及彩超的应用价值。方法选择2018年6月至2020年4月在广东省肇庆市中医院收治的113例急性脑梗死患者的临床资料,根据CT影像资料将患者分为大面积脑梗死组(梗死直径≥5 cm,n=38)和非大面积脑梗死组(梗死直径<5 cm,n=75),同时纳入此时段在本院体检中心进行常规体检的60例老年体检者作为对照组。采用彩超比较3组患者颈动脉内膜中层厚度(intima-media thickness,IMT)和颈动脉斑块检出率、斑块内部声学特征、斑块积分。然后根据3组患者的IMT数值分为IMT正常组(n=46)、IMT增厚组(n=71)和斑块形成组(n=56),分析3组患者Lp-PLA2和hs-CRP的表达水平,采用Pearson分析IMT与Lp-PLA2和hs-CRP的相关性。结果对照组、大面积脑梗死组和非大面积脑梗死组IMT分别为(0.94±0.18),(1.72±0.21)和(1.27±0.20)mm,3组患者的IMT比较差异有统计学意义(F=26.66,P<0.001);对照组、大面积脑梗死组和非大面积脑梗死组斑块检出率分别为35.0%,97.3%和70.6%,大面积脑梗死组斑块检出率显著高于其他两组(χ^(2)=41.79,P<0.001),其中混合声斑、等回声斑和强回声斑的人数显著高于其他两组(P<0.05);对照组、大面积脑梗死组和非大面积脑梗死组的斑块积分分别为(3.37±1.26),(9.74±2.39)和(6.44±1.66),单因素方差分析示3组患者的斑块积分差异有统计学意义(F=18.08,P<0.001);IMT正常组Lp-PLA2和hs-CRP水平分别为(146.3±17.8)μg/L和(3.04±0.56)mg/L,斑块形成组、IMT增厚组Lp-PLA2和hs-CRP水平分别为(236.8±26.8)μg/L,(17.15±2.25)mg/L和(197.2±22.2)μg/L,(10.47±1.37)mg/L,3组患者的Lp-PLA2(F=24.24,P<0.001)和hs-CRP水平(F=123.7,P<0.001)比较差异有统计学意义。Pearson相关性分析结果显示,IMT与Lp-PLA2(r=0.58,P<0.05),hs-CRP(r=0.64,P<0.05)均呈正相关。结论脑梗死患者颈动脉粥样硬化进展程度与血清Lp-PLA2,hs-CRP水平升高有关,并且彩超对评估脑梗死严重程度有重要的临床应用价值。

Objective To explore the correlation between Lp-PLA2,hs-CRP and the degree of carotid atherosclerosis in patients with cerebral infarction and the application value of color doppler ultrasonography.Methods The clinical data of 113 patients with acute cerebral infarction admitted to the hospital of Traditional Chinese Medicine of Zhaoqing from June 2018 to April 2020 were divided into a large area cerebral infarction group(infarct diameter≥5 cm,n=38)and a non-large area cerebral infarction group(infarct diameter<5 cm,n=75)according to CT image data,and 60 elderly patients who had routine physical examination in the Physical Examination Center of our hospital were enrolled as a control group.The intima-media thickness,detection rates of plaque,acoustic characteristics of interior plaque,and plague score were compared by color doppler ultrasonography.And then all patients were divided into an IMT normal group(n=46),an IMT thickening group(n=71)and a plaque formation group(n=56)according to the IMT values.The expression levels of Lp-PLA2 and hs-CRP in the 3 groups were analyzed and correlation between IMT and Lp-PLA2,hs-CRP were analyzed by Pearson.Results The IMT in the control group,the large area cerebral infarction group,and the non large area cerebral infarction group were(0.94±0.18),(1.72±0.21),(1.27±0.20)mm,respectivels.The IMT among the 3 groups was statistically different(F=26.66,P<0.001).The plaque detection rate of the control group,large area cerebral infarction group and non large area cerebral infarction group were 35.0%,97.3%and 70.6%,respectively.The plaque detection rate of large area cerebral infarction group was significantly higher than that of the other 2 groups(χ^(2)=41.79,P<0.001),in which the numbers of mixed,iso-echoic and hyper-echoic spots were significantly higher than those of the other 2 groups(P<0.05).The plaque score of the control group was(3.37±1.26),while the plaque score in the large area cerebral infarction group and the non large area cerebral infarction group were(9.74±2.39)and(6.44±1.66),respectively.The plaque score of the 3 groups was statistically different(F=18.08,P<0.001).The levels of Lp-PLA2 and hs-CRP in the IMT normal group were(146.3±17.8)μg/L and(3.04±0.56)mg/L,respectively.Besides,the levels of Lp-PLA2 and hs-CRP in the plaque formation group were(236.8±26.8)μg/L,(17.15±2.25)mg/L,while those in the IMT thickening group were(197.2±22.2)μg/L,(10.47±1.37)mg/L,respectively.The levels of Lp-PLA2 and hs-CRP in the 3 groups were significant different(Lp-PLA2:F=24.24,P<0.001;hs-CRP:F=123.7,P<0.001).Pearson correlation analysis showed that IMT was positively correlated with Lp-PLA2(r=0.58,P<0.05),hs-CRP(r=0.64,P<0.05).Conclusion The progression of carotid atherosclerosis in patients with cerebral infarction is related to the increase of serum Lp-PLA2 and hs-CRP levels,and color doppler ultrasonography has important clinical value in assessing the severity of cerebral infarction.