缺血性卒中患者颈动脉硬化斑块稳定性与血清PAPP-A及预后的相关性

Correlation between carotid atherosclerotic plaque stability and the serum levels of PAPP-A and the prognosis in patients with ischemic stroke

目的探讨缺血性脑卒中患者颈动脉斑块不稳定性的新型血清标志物——妊娠相关蛋白-A(PAPP-A)及预后评估。方法选择84例缺血性脑卒中患者,根据颈动脉超声检查分为稳定斑块组和不稳定斑块组;比较两组血清PAPP-A水平;随访两组患者1年,分别测定患者治疗前、治疗后4周及治疗后1年的美国国立卫生研究院脑卒中评分(NIHSS)及日常生活活动能力评分(ADL),比较两组评分变化,探讨其对缺血性脑卒中患者预后的评估价值。结果颈动脉不稳定斑块组血清PAPP-A水平显著高于稳定斑块组(P<0.01);PAPP-A对不稳定关系的诊断评估显示曲线下面积(AUC)分别为0.811。不稳定斑块组治疗后1年NIHSS评分高于稳定斑块组,但ADL评分两组无统计学差异。结论血清PAPP-A水平与颈动脉斑块不稳定性相关,缺血性脑卒中患者合并不稳定斑块往往预后较差,需要严密的临床随访。

Objective To explore a new serum marker of carotid artery plaque instability——pregnancy-associated protein-A(PAPP-A)and to evaluate its prognosis in patients with ischemic stroke.Methods 84 patients with ischemic stroke were selected and divided into stable plaque group and unstable plaque group according to carotid ultrasound examination.Then the serum levels of PAPP-A were compared between the two groups.Besides,the National Insititutes of Health stroke scale(NIHSS)scores and activity of daily living scale(ADL)scores of the two groups were assessed respectively at three timepoint:before treatment,the 4th week and 12th month after treatment during 1 year’s following up.Simultaneously,the changes of the scores were compared,to explore their roles in evaluating the prognosis of patients with ischemic stroke.Results The serum levels of PAPP-A in the unstable plaque group were significantly higher than those in the stable plaque group(P<0.01).The area under the curve(AUC)was 0.811 when assessing the predictive value of PAPP-A towards unstable plaque.The NIHSS scores in the unstable plaque group was higher than that in the stable plaque group,while there was no statistical difference in ADL scoresbetween the two groups.Conclusion The serum level of PAPP-A is related to the instability of carotid artery plaque.Patients with ischemic stroke with unstable plaques are more likely tohave poor prognosis.Therefore,rigorous clinical follow-up is recommended.