血清ANXA2、ADAMTS4水平与短暂性脑缺血发作患者颈动脉斑块性质的关系

Relationships between serum ANXA2 and ADAMTS4 levels and character of carotid plaque in patients with transient ischemic attack

目的探讨血清膜联蛋白A2(ANXA2)、血小板反应蛋白解整合素金属肽酶4(ADAMTS4)水平与短暂性脑缺血发作(TIA)患者颈动脉斑块性质的关系。方法选择TIA患者156例(观察组)、同期体检健康的志愿者78例(对照组),采集所有研究对象外周静脉血,离心留取血清,采用ELISA法检测血清ANXA2、ADAMTS4。TIA患者入院后接受颈动脉血管超声检查,由两名经验丰富的影像科医师评估颈动脉斑块形成及稳定性。采用多因素Logistic回归模型分析TIA患者颈动脉斑块不稳定的危险因素。采用受试者工作特征(ROC)曲线分析血清ANXA2、ADAMTS4水平对TIA患者颈动脉斑块不稳定的预测价值。结果观察组血清ANXA2、ADAMTS4水平均高于对照组(t分别为16.636、25.358,P均<0.05)。颈动脉血管超声检查发现,TIA患者颈动脉斑块不稳定者76例、颈动脉斑块稳定或无颈动脉斑块者80例,颈动脉斑块不稳定的发生率为48.72%(76/156)。单因素分析发现,TIA患者颈动脉斑块不稳定与年龄、吸烟、饮酒、合并高血压、卒中风险及血清ANXA2、ADAMTS4水平有关(P均<0.05);多因素Logistic回归分析显示,吸烟、饮酒、卒中风险增加以及血清ANXA2、ADAMTS4水平升高为TIA患者颈动脉斑块不稳定的独立危险因素(P均<0.05)。ROC曲线分析显示,血清ANXA2、ADAMTS4水平单独和联合预测TIA患者颈动脉斑块不稳定的曲线下面积(AUC)分别为0.787、0.780、0.874,血清ANXA2、ADAMTS4水平联合预测TIA患者颈动脉斑块不稳定的AUC大于二者单独(Z分别为3.151、3.326,P均<0.05)。结论血清ANXA2、ADAMTS4水平升高是导致TIA患者颈动脉斑块不稳定的独立危险因素;血清ANXA2、ADAMTS4水平对TIA患者颈动脉斑块不稳定均有一定预测价值,二者联合预测价值更高。

Objective To investigate the relationships between serum levels of membrane-bound protein A2(ANXA2),a disintegrin and metalloproteinase with thrombospondin motifs-4(ADAMTS4)and character of carotid plaque in patients with transient ischemic attack(TIA).Methods Totally 156 patients with TIA(observation group)were selected for carotid artery vascular ultrasound,and 78 healthy volunteers undergoing physical examination during the same period(control group)were selected.The peripheral venous blood was collected from all the study subjects,centrifuged and retained for serum,and serum ANXA2 and ADAMTS4 were detected by ELISA.Patients with TIA were admitted to the hospital and underwent carotid vascular ultrasound to assess carotid plaque formation and stability by two experienced imaging physicians.Risk factors for carotid plaque instability in TIA patients were analyzed using multifactorial Logistic regression model.The predictive value of serum ANXA2 and ADAMTS4 levels for carotid plaque instability in TIA patients was analyzed using the receiver operating characteristic(ROC)curve.Results The serum ANXA2 and ADAMTS4 levels of the observation group were higher than those of the control group(t=16.636,25.358,both P<0.05).Carotid artery vascular ultrasound examination revealed that there were 76 cases of carotid plaque instability and 80 cases of carotid plaque stability or no carotid plaque in TIA patients,and the incidence of carotid plaque instability was 48.72%(76/156).Univariate analysis revealed that carotid plaque instability in TIA patients was associated with age,smoking,alcohol consumption,comorbid hypertension,stroke risk,and serum ANXA2 and ADAMTS4 levels(all P<0.05);multi‑factorial Logistic regression analysis showed that smoking,alcohol consumption,increased risk of stroke,and elevated serum ANXA2 and ADAMTS4 levels were the independent risk factors for carotid plaque instability(all P<0.05).ROC curve analysis showed that the AUC of serum ANXA2 and ADAMTS4 levels alone and in combination in predicting carotid plaque instability in TIA patients was 0.787,0.780,and 0.874,respectively,and the AUC of serum ANXA2 and ADAMTS4 levels in predicting carotid plaque instability in TIA patients was greater than that of either alone(Z=3.151,3.326,both P<0.05).Conclusion Serum ANXA2 and ADAMTS4 levels increased in patients with TIA,and the elevated levels of them are independent risk factors for carotid plaque instability;serum ANXA2 and ADAMTS4 levels have a certain predic‑tive value for carotid plaque instability in patients with TIA,and the predictive value of them combined is higher.