外周血载脂蛋白A1、载脂蛋白B、脂蛋白(a)在颈动脉粥样硬化斑块易损性评价中的价值研究

Value of peripheral blood ApoA1,ApoB,LP(a)in evaluation of vulnerability of carotid atherosclerotic plaque

目的:分析外周血载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白(a)[LP(a)]水平联合评价颈动脉粥样硬化斑块易损性的价值。方法:选取行超声检查具有颈动脉粥样硬化的156例患者为疾病组,根据超声造影检查结果将患者分为易损斑块组(76例)和非易损斑块组(80例),另同期选取本院150例健康体检者为对照组。检测并比较各组外周血ApoA1、ApoB、LP(a)水平,采用多因素Logistics多元回归分析法分析影响颈动脉粥样硬化斑块易损性的因素,并绘制受试者工作特征(ROC)曲线分析三者单独及联合检测对颈动脉粥样硬化斑块易损性的评估价值。结果:疾病组ApoA1水平低于对照组(P<0.05),ApoB、LP(a)水平高于对照组(均P<0.05);易损斑块组ApoA1水平低于非易损斑块组(P<0.05),ApoB、LP(a)水平高于非易损斑块组(均P<0.05);多因素Logistic回归分析结果显示有糖尿病史、尿酸(UA)≥447.34μmol/L、C反应蛋白(CRP)≥13.52 mg/L、低密度脂蛋白(LDL)≥3.87 mmol/L、ApoA1<1.09 g/L、ApoB≥1.51 g/L、LP(a)≥283.04 mg/L均为颈动脉粥样硬化斑块易损性的独立危险因素(均P<0.05);ROC结果显示,ApoA1、ApoB、LP(a)三者联合评价颈动脉粥样硬化斑块易损性的灵敏度、特异度、曲线下面积(AUC)分别为93.42%、82.50%、0.925,联合评估的灵敏度高于单独评估(P<0.05),AUC高于单独评估(P<0.05),特异度与单独评估比较差异无统计学意义(P>0.05)。结论:ApoA1、ApoB、LP(a)均是颈动脉粥样硬化斑块易损性的影响因素,三者联合检测用来评估颈动脉粥样硬化斑块的易损性具有较大的价值。

Objective:To analyze the value of peripheral blood apolipoprotein A1(ApoA1),apolipoprotein B(ApoB),lipoprotein(a)[LP(a)]levels in joint evaluation of carotid atherosclerotic plaque vulnerability.Methods:A total of 156 patients with carotid atherosclerosis who underwent ultrasonography were selected as the disease group.According to the results of ultrasonography,the patients were divided into vulnerable plaque group(76 cases)and non-vulnerable plaque group(80 cases).During the same period,150 healthy subjects were selected as the control group.The levels of ApoA1,ApoB,and LP(a)in peripheral blood of each group were detected and compared.Multivariate Logistic regression was used to analyze the factors affecting the vulnerability of carotid atherosclerotic plaque,and the ROC curve was used to analyze the evaluation value of individual and combined detection on the vulnerability of carotid atherosclerotic plaque.Results:The ApoA1 level in the disease group was lower than that in the control group,and the ApoB and LP(a)levels were higher than those in the control group(all P<0.05).The ApoA1 level in the vulnerable plaque group was lower than that in the non-vulnerable plaque group,and the levels of ApoB and LP(a)were higher than those in the non-vulnerable plaque group(all P<0.05).Multivariate Logistic regression analysis showed that there was a history of diabetes,UA≥447.34μmol/L,CRP≥13.52 mg/L,LDL≥3.87 mmol/L,ApoA1<1.09 g/L,ApoB≥1.51 g/L,LP(a)≥283.04 mg/L were independent risk factors for carotid atherosclerotic plaque vulnerability(all P<0.05).ROC results showed that the sensitivity,specificity,and area under the curve(AUC)of ApoA1,ApoB,and LP(a)in evaluating the vulnerability of carotid atherosclerotic plaque were 93.42%,82.50%,and 0.925,respectively,and the sensitivity of joint evaluation was higher than that of single evaluation(P<0.05),and the AUC was higher than that of single evaluation(P<0.05),and the specificity was not significantly different from that of single evaluation(P>0.05).Conclusion:ApoA1,ApoB,and LP(a)are all influencing factors of the vulnerability of carotid atherosclerotic plaque,and the combined detection of the three is of great value in evaluating the vulnerability of carotid atherosclerotic plaque.