脑梗死早期颈内动脉支架置入前后血清脂蛋白相关磷脂酶A2的变化及对预后情况的影响研究

Changes of serum lipoprotein-associated phospholipase A 2 before and after internal carotid artery stent implantation in early cerebral infarction and its impact on prognosis

目的观察脑梗死早期实施颈内动脉支架置入术治疗前后的血清脂蛋白相关磷脂酶A2(Lp-PLA2)水平变化情况以及对患者预后情况的影响。方法本次研究选择洛阳伊洛医院2021年1月至2022年1月期间收治的98例脑梗死患者作为研究对象,所有患者均在发病4.5 h以内接受早期颈内动脉支架置入术(CAS)治疗,治疗后均开展为期6个月的随访,比较入组患者治疗前、治疗后次日的Lp-PLA2水平、卒中量表(NIHSS)、改良Rakin量表(mRS)评分变化情况;经Spearman相关性系数检验Lp-PLA2水平与CAS治疗效果间的相关性;根据mRS评分结果,将mRS评分为0~2分患者列为预后良好组,将mRS评分为3~6分患者列为预后不良组,比较两组患者Lp-PLA2水平间的差异,通过绘制受试者工作特征(ROC)曲线及曲线下面积(AUC)评估Lp-PLA2对脑梗死患者接受CAS治疗后对其预后情况的预测效能。结果早期实施CAS治疗后,98例患者的Lp-PLA2为(202.45±50.27)ng/mL,NIHSS评分为(15.44±5.16)分,mRS评分为(3.61±0.32)分,均低于治疗前[(244.52±50.16)ng/mL、(18.32±5.26)分、(5.72±1.31)分](P<0.05);经Spearman相关性系数检验,脑梗死患者行CAS治疗后的Lp-PLA2表达水平与NIHSS评分、mRS评分正相关;98例患者中共有28例判定为预后不良,对应的Lp-PLA2表达水平为(210.75±50.61)ng/mL,高于预后良好组(188.72±50.44)ng/mL(P<0.05)。经ROC曲线验证,Lp-PLA2指标对预后水平预测的灵敏度为81.45%、特异度为78.44%、截断值为200 ng/mL、AUC=0.854。结论对脑梗死患者早期实施CAS治疗可有效促进脑神经功能恢复,Lp-PLA2水平与CAS治疗效果密切相关,可实现对患者预后水平的有效预测。

【Objective】To observe the changes in lipoprotein-associated phospholipase A2(Lp-PLA2)levels before and after the early implementation of carotid artery stenting(CAS)treatment for cerebral infarction,as well as the impact on the prognosis of patients.【Methods】This study selected 98 patients with cerebral infarction admitted between January 2021 and January 2022 as the research subjects.All patients received early CAS treatment within 4.5 hours of onset,and were followed up for 6 months after treatment.The changes in Lp-PLA2 levels,National Institutes of Health Stroke Scale(NIHSS),and Modified Rankin Scale(mRS)scores of the enrolled patients were compared before and the day after treatment.The correlation between Lp-PLA2 level and CAS treatment efficacy was tested by Spearman correlation coefficient.Based on the mRS scoring results,patients with mRS scores of 0–2 were classified as a good prognosis group,and patients with mRS scores of 3–6 were classified as a poor prognosis group.The differences in Lp-PLA2 levels between the two groups of patients were compared,and the predictive efficacy of Lp-PLA2 on the prognosis of cerebral infarction patients receiving CAS treatment was evaluated by plotting reciever operating characteristic(ROC)curve and the area under the curve.【Results】After early implementation of CAS treatment,the Lp-PLA2 of 98 patients was 202.45±50.27 ng/mL,NIHSS score was 15.44±5.16 points,mRS score was 3.61±0.32 points,both lower than those before treatment(244.52±50.16 ng/mL,18.32±5.26 points,5.72±1.31 points)(P<0.05).According to Spearman correlation coefficient test,the expression level of Lp-PLA2 in patients with cerebral infarction after CAS treatment is positively correlated with NIHSS score and mRS score.A total of 28 out of 98 patients were determined to have poor prognosis,and the corresponding expression level of Lp-PLA2 was 210.75±50.61 ng/mL,which was higher than that of the group with good prognosis(188.72±50.44 ng/mL)(P<0.05).After validation by the ROC curve,the Lp-PLA2 indicator for predicting prognosis's sensitivity was 81.45%,specificity was 78.44%,truncation value was 200 ng/mL,and AUC=0.854.【Conclusion】Early implementation of CAS treatment for cerebral infarction patients can effectively promote the recovery of brain nerve function,and the level of Lp-PLA2 is closely related to the effectiveness of CAS treatment,which can effectively predict the prognosis of patients.