探讨血清Lp-PLA2、Hcy、UA水平联合预测急性脑梗死近期预后不良的价值分析

Analysis of combined prediction value of serum Lp-PLA2,Hcy and UA levels in poor short-term prognosis of acute cerebral infarction

目的探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)、同型半胱氨酸(Hcy)、尿酸(UA)水平联合预测急性脑梗死(ACI)近期预后不良的价值。方法选取2020年5月—2022年8月在本院收治的158例ACI患者为研究组,另选取同期158例健康体检者为对照组,受试对象均检测血清Lp-PLA2、Hcy、UA水平。另根据随访90 d时的改良Rankin量表(mRS)评分标准,将ACI患者分为预后良好者(mRS评分≤2分)和预后不良者(mRS评分>2分)。对比研究组与对照组、预后不良者与预后良好者血清Lp-PLA2、Hcy、UA水平,采用logistic多元回归分析ACI患者近期预后不良的影响因素;绘制受试者工作特征(ROC)曲线,分析血清Lp-PLA2、Hcy、UA水平联合对ACI近期预后不良的预测价值。结果研究组血清Lp-PLA2、Hcy、UA水平均高于对照组(P<0.05);158例ACI患者中有62例近期预后不良,预后不良发生率为39.24%;预后不良者血清Lp-PLA2、Hcy、UA水平均高于预后良好者,差异均有统计学意义(P<0.05);logistic多元回归分析显示,合并高血压、心房颤动、大面积梗死、发病至入院时间、入院时美国国立卫生研究院卒中量表(NIHSS)评分、糖化血红蛋白水平(HbA1c)、颈动脉斑块、胱抑素C(Cys C)水平及血清Lp-PLA2、Hcy、UA水平均是ACI患者近期预后不良的危险因素(P<0.05);血清Lp-PLA2、Hcy、UA水平联合预测近期预后不良的灵敏度(96.77%)、曲线下面积(AUC)(0.889)均高于单独预测(P<0.05),特异度(79.17%)与单独预测对比差异无统计学意义(P>0.05)。结论ACI患者血清Lp-PLA2、Hcy、UA水平均异常升高,且各血清指标均与ACI近期预后不良关系密切,均对ACI患者近期预后不良具有一定的预测价值,但联合预测价值更高。

Objective This paper aims to investigate the value of serum lipoprotein associated phospholipase A2(Lp-PLA2),homocysteine(Hcy)and uric acid(UA)levels in combined prediction of the poor prognosis of acute cerebral infarction(ACI).Methods A total of 158 patients with ACI admitted to our hospital from May 2020 to August 2022 were selected as the study group,and 158 healthy people in the same period were selected as the control group.All subjects underwent the test of serum Lp-PLA2,Hcy and UA levels.ACI patients were divided into good prognosis patients(mRS score≤2 points)and poor prognosis patients(mRS score>2 points)according to the modified Rankin Scale(mRS)score standard at 90 d of follow-up.The serum levels of Lp-PLA2,Hcy and UA were compared between the study group and the control group,and the poor prognosis patients and the good prognosis patients.The influencing factors of poor prognosis in ACI patients were analyzed by logistic multiple regression.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive values of the combination of serum Lp-PLA2,Hcy and UA levels for the poor short-term prognosis of ACI.Results The levels of serum Lp-PLA2,Hcy and UA in the study group were higher than those in the control group(P<0.05).Among 158 patients with ACI,62 had poor short-term prognosis,and the incidence rate of poor prognosis was 39.24%.The serum levels of Lp-PLA2,Hcy and UA in the poor prognosis patients were higher than those in the good prognosis patients,with the differences of statistical significance(P<0.05).Logistic multiple regression analysis showed that hypertension,atrial fibrillation,large-scale infarction,time from onset to admission,National Institutes of Health Stroke Scale(NIHSS)score at admission,glycosylated hemoglobin level(HbA1c),carotid plaque,Cystatin C(Cys C)and serum Lp-PLA2,Hcy and UA levels were all risk factors for poor short-term prognosis in ACI patients(P<0.05).The sensitivity(96.77%)and area under the curve(AUC)(0.889)of the combined prediction of serum Lp-PLA2,Hcy and UA levels for poor short-term prognosis were higher than those of single prediction(P<0.05),but there was no statistical significance on the difference in the specificity between combined prediction(79.17%)and single prediction(P>0.05).Conclusion The levels of serum Lp-PLA2,Hcy and UA in patients with ACI increase abnormally,and all serum indicators are closely related to the poor short-term prognosis of ACI,which all have a certain predictive value for the poor short-term prognosis of ACI patients,but the value of combined prediction is higher.