老年慢性脑供血不足患者血清LTB4、MMP-9水平对颈动脉斑块形成的诊断价值

The diagnostic value of serum LTB4 and MMP-9 levels in elderly patients with chronic cerebral insufficiency in carotid plaque formation

目的分析老年慢性脑供血不足患者血清白三烯B4(LTB4)、基质金属蛋白酶-9(MMP-9)水平对颈动脉斑块形成的诊断价值。方法选择2020年9月—2021年7月在西安交通大学第一附属医院神经内科就诊的老年慢性脑供血不足患者126例作为研究对象,患者均行颈动脉彩色多普勒超声检查,根据颈动脉内膜中层厚度(IMT)将患者分为正常组44例(IMT<1 mm)、内膜增厚组41例(1 mm≤IMT<1.5 mm)、斑块形成组41例(IMT≥1.5 mm)。根据颈动脉彩色多普勒超声特点,将斑块形成组患者分为易损斑块亚组18例,稳定斑块亚组23例。检测各组患者血清LTB4、MMP-9水平;Logistic回归分析老年慢性脑供血不足患者颈动脉斑块形成的影响因素;受试者工作特征曲线(ROC)分析血清LTB4、MMP-9水平对老年慢性脑供血不足患者颈动脉斑块形成的诊断价值。结果正常组、内膜增厚组、斑块形成组血清LTB4、MMP-9水平依次升高(F/P=95.143/<0.001、68.548/<0.001);易损斑块亚组血清LTB4、MMP-9水平较稳定斑块亚组明显升高(t/P=10.237/<0.001、8.402/<0.001);高血压、高脂血症及血清LTB4、MMP-9水平升高均是老年慢性脑供血不足患者颈动脉斑块形成的危险因素[OR(95%CI)=1.182(1.119~1.542)、1.419(1.128~1.759)、1.651(1.271~2.137)、1.748(1.353~2.284)];血清LTB4、MMP-9水平及二者联合诊断老年慢性脑供血不足患者颈动脉斑块形成的曲线下面积(AUC)为0.796、0.821、0.879,二者联合高于单独诊断(Z/P=13.563/<0.001、18.208/<0.001)。结论血清LTB4、MMP-9水平与老年慢性脑供血不足患者颈动脉斑块形成密切相关,二者水平升高是颈动脉斑块形成的危险因素,可作为诊断老年慢性脑供血不足患者颈动脉斑块形成的生物标志物。

Objective To analyze the diagnostic value of serum leukotriene B4(LTB4)and matrix metalloproteinase-9(MMP-9)levels for carotid plaque formation in elderly patients with chronic cerebral insufficiency.Methods A total of 126 elderly patients with chronic cerebral insufficiency who were treated in the Department of Neurology,The First Affiliated Hospital of Xi’an Jiaotong University from September 2020 to July 2021 were selected as the research subjects.All patients underwent carotid artery color Doppler ultrasonography.According to the medial thickness(IMT),the patients were divided into normal group(44 cases)(IMT<1 mm),41 cases of intimal thickening group(1 mm≤IMT<1.5 mm),and plaque formation group(41 cases)(IMT≥1.5 mm).According to the characteristics of carotid color Doppler ultrasound,the patients in the plaque formation group were divided into vulnerable plaque subgroup of 18 cases and stable plaque subgroup of 23 cases.Serum LTB4 and MMP-9 levels were detected in each group.Logistic regression analysis of the influencing factors of carotid plaque formation in elderly patients with chronic cerebral insufficiency;receiver operating characteristic curve(ROC)analysis of serum LTB4 and MMP-9 levels in the diagnosis of carotid plaque formation in elderly patients with chronic cerebral insufficiency.Results The levels of serum LTB4 and MMP-9 in the normal group,intimal thickening group and plaque formation group were increased in turn(F/P=95.143/<0.001,68.548/<0.001).The levels of serum LTB4 and MMP-9 in the vulnerable plaque subgroup were significantly higher than those in the stable plaque subgroup(t/P=10.237/<0.001,8.402/<0.001).Hypertension,hyperlipidemia,and elevated levels of serum LTB4 and MMP-9 were all risk factors for carotid plaque formation in elderly patients with chronic cerebral insufficiency[OR(95%CI)=1.182(1.119-1.542),1.419(1.128-1.759),1.651(1.271-2.137),1.748(1.353-2.284)].The areas under the curve(AUC)of serum LTB4 and MMP-9 levels and their combination in diagnosing carotid plaque formation in elderly patients with chronic cerebral insufficiency were 0.796,0.821,and 0.879,and the combination of the two was higher than the independent diagnosis(Z/P=13.563/<0.001,18.208/<0.001).Conclusion Serum LTB4 and MMP-9 levels are closely related to carotid plaque formation in elderly patients with chronic cerebral insufficiency,both are risk factors for carotid plaque formation and can be used as biomarkers for diagnosing carotid plaque formation in elderly patients with chronic cerebral insufficiency.