急性脑梗死患者血清脂蛋白相关磷脂酶A2、同型半胱氨酸和尿酸水平与颈动脉硬化的相关性

Correlation between serum lipoprotein-associated phospholipase A2,homocysteine,uric acid levels and carotid atherosclerosis in patients with acute cerebral infarction

目的 探讨急性脑梗死患者血清脂蛋白相关磷脂酶A2(Lipoprotein Associated Phospholipase,Lp-PLA2)、同型半胱氨酸(Homocysteine,Hcy)和尿酸(Uric acid,UA)水平与颈动脉硬化的相关性及其临床意义。方法 收集抚顺市中心医院神经内科2020年12月至2021年12月住院的首次发病的急性脑梗死患者作为研究组,同期健康体检者为对照组。研究组根据颈动脉超声检查有无斑块及斑块性质将研究组分为无斑块、斑块稳定和斑块不稳定3个亚组,斑块稳定组和不稳定组为动脉硬化组,根据狭窄程度分为轻、中、重度狭窄3个亚组。测定Lp-PLA2、Hcy和UA水平,并对上述指标进行分析。结果 ①两组在性别、年龄、饮酒、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)和甘油三酯(triacylglyceride,TG)方面无统计学差异(P>0.05);在高血压、糖尿病、吸烟、血清总胆固醇(cholesterol,CHOL)和低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、Lp-PLA2、Hcy和UA方面均有显著性差异(P<0.05)。②与稳定斑块亚组相比,不稳定斑块亚组Lp-PLA2、Hcy水平都高,差别具有统计学意义(P<0.05)。③与轻度狭窄亚组相比,中度和重度狭窄亚组患者血清Lp-PLA2活性和Hcy水平依次递增,Lp-PLA2和Hcy水平与狭窄程度呈正相关(P<0.05);与轻度狭窄亚组相比,中度狭窄亚组UA水平增高不明显(P>0.05);与中度狭窄亚组相比,重度狭窄亚组UA水平增高。④Logistic回归分析结果显示,Lp-PLA2(OR=1.004,P=0.046)和Hcy(OR=1.374,P=0.000)是颈动脉硬化的独立危险因素。⑤绘制ROC曲线显示,Lp-PLA2的AUC为0.743,截取值取482.89U/L时,敏感度为73.7%,特异性为70.8%;Hcy的AUC为0.814,截取值取12.77μmol/L时,敏感度为71.3%,特异性为83.3%;UA的AUC为0.624,截取值取308.39μmol/L时,敏感度为58.1%,特异性66.7%。其中以Hcy曲线下面积最大,且约登指数最高,对颈动脉硬化的诊断最有价值。结论 急性脑梗死患者血清Lp-PLA2和Hcy水平与颈动脉斑块的不稳定及狭窄程度密切相关,Lp-PLA2、Hcy和UA可作为临床预测指标,预测颈动脉硬化发生的可能,Lp-PLA2、Hcy预测价值较UA高。

Objective To investigate the serum Lipoprotein Associated Phospholipase A2(Lp-PLA2),Homocysteine(Hcy)and Uric acid(UA)in patients with acute cerebral infarction.UA level and carotid atherosclerosis and its clinical significance.Methods Patients with acute cerebral infarction who were hospitalized for the first time from December 2020 to December 2021 in the Department of Neurology of Fushun Central Hospital were selected as the study group,and healthy subjects during the same period were selected as the control group.The study group was divided into three subgroups:no plaque,stable plaque and unstable plaque according to the presence and nature of carotid artery ultrasonography.The stable plaque group and unstable plaque group were atherosclerosis group,and they were divided into three subgroups:mild,moderate and severe stenosis according to the degree of stenosis.The levels of Lp-PLA2,Hcy and UA were determined and analyzed.Results①There were no statistically significant differences in gender,age,alcohol consumption,high density lipoprotein cholesterol(HDL-C)and triacylglyceride(TG)between the two groups(P>0.05).There were significant differences in the levels of serum total cholesterol(CHOL),low density lipoprotein cholesterol(LDL-C)hypertension,diabetes,smoking,Lp-PLA2,Hcy and UA(P<0.05).②Compared with the stable plaque subgroup,the levels of Lp-PLA2 and Hcy were higher in the unstable plaque subgroup,and the difference was statistically significant(P<0.05).③Compared with the mild stenosis subgroup,the serum Lp-PLA2 activity and Hcy level in moderate and severe stenosis subgroup increased successively,and the Lp-PLA2 and Hcy levels were positively correlated with the degree of stenosis(P<0.05).Compared with the mild stenosis subgroup,the level of UA in moderate stenosis subgroup was not significantly increased(P>0.05).The level of UA in severe stenosis group was higher than that in moderate stenosis group.④Logistic regression analysis showed that Lp-PLA2(OR=1.004,P=0.046)and Hcy(OR=1.374,P=0.000)were independent risk factors for carotid atherosclerosis.⑤ROC curve drawing showed that the AUC of Lp-PLA2 was 0.743,and the sensitivity and specificity were 73.7%and 70.8%when the intercept value was 482.89U/L.The AUC of Hcy was 0.814,and the sensitivity and specificity were 71.3%and 83.3%when the intercept value was 12.77μmol/L.The AUC of UA was 0.624,and the sensitivity and specificity were 58.1%and 66.7%when the interception value was 308.39μmol/L.Among them,the area under Hcy curve is the largest and the Jorden index is the highest,which is the most valuable for the diagnosis of carotid atherosclerosis.Conclusion Serum Lp-PLA2 and Hcy levels in patients with acute cerebral infarction are closely related to the instability and stenosis degree of carotid plaque.Lp-PLA2,Hcy and UA can be used as clinical predictive indicators to predict the occurrence of carotid atherosclerosis,and the predictive value of Lp-PLA2 and Hcy is higher than that of UA.