血清LP-PLA2和MMP-9水平与2型糖尿病合并脑梗死患者颈动脉斑块易损性的相关性

Correlation analysis of serum LP-PLA2,MMP-9 levels with carotid plaque vulnerability in type 2 diabetes mellitus patients with cerebral infarction

目的 探讨血清脂蛋白相关磷脂酶A2(LP-PLA2)、基质金属蛋白酶-9(MMP-9)水平与2型糖尿病合并脑梗死患者颈动脉斑块易损性的相关性。方法 回顾性研究2020年2月至2023年1月在沧州市人民医院住院治疗的102例2型糖尿病合并脑梗死患者的临床资料,根据粥样斑块性质分组:50例患者为颈动脉斑块易损(易损组),52例患者为稳定性颈动脉斑块(稳定组)。对比不同颈动脉斑块易损性患者的各项影响因素(性别、年龄、体重指数、合并高血压、合并高血脂症、血糖、血脂等);采用多因素Logistics回归分析影响颈动脉斑块易损性的因素;并以受试者操作特征(ROC)分析LP-PLA2、MMP-9单独及联合检查对颈动脉斑块易损性的预测价值。结果 稳定组与易损组患者的性别构成比、年龄、体重指数、合并高血压、合并高血脂症、甘油三酯、高密度脂蛋白胆固醇(HDL-C)比较,差异均无统计学意义(P>0.05),易损组患者的空腹血糖、HbA1c、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、LP-PLA2、MMP-9水平分别为(6.19±0.88) mmol/L、(10.21±1.16)%、(4.87±0.87) mmol/L、(2.90±0.45) mmol/L、(363.16±52.78) pg/L、(83.36±11.29) pg/L,均明显高于稳定组[(5.81±0.44) mmol/L、(9.71±1.21)%、(4.51±0.55) mmol/L、(2.44±0.33) mmol/L、(292.44±47.27)pg/L、(60.46±9.85) pg/L],差异均有统计学意义(P<0.05)。多因素Logistics回归分析结果显示,HbA1c、LP-PLA2、MMP-9确定为影响2型糖尿病合并脑梗死患者颈动脉斑块易损性的独立因素(P<0.05)。LP-PLA2、MMP-9单独及联合检查预测颈动脉斑块易损性均有较高的准确性(P<0.05)。结论 糖尿病类型2合并脑梗死的患者颈动脉中存在不稳定的斑块的风险较高,而联合应用LP-PLA2与MMP-9作为标志物,对于颈动脉不稳定斑块的稳定性显现出较好的预测效果。

Objective To analyze the correlation between serum levels of lipoprotein-associated phospholipase A2(LP-PLA2)and matrix metalloproteinase-9(MMP-9)and the vulnerability of carotid artery plaque in patients with type 2 diabetes mellitus complicated with cerebral infarction.Methods A retrospective study was conducted on the clinical data of 102 patients with type 2 diabetes mellitus complicated with cerebral infarction who were hospitalized in Cangzhou People's Hospital from February 2020 to January 2023.According to the nature of atherosclerotic plaques,50 patients were vulnerable to carotid plate(vulnerable group),52 patients were stable carotid plaque(stable group).The influencing factors(gender,age,body mass index,hypertension,hyperlipidemia,blood glucose,blood lipid,etc.)of patients with different carotid plaque vulnerability were compared.The factors affecting the vulnerability of carotid plaque were analyzed by multivariate Logistics regression analysis.The predictive value of LP-PLA2 and MMP-9 alone and in combination to carotid plaque vulnerability was analyzed with receiver operating characteristic(ROC)curve.Results There were no statistically significant differences in sex ratio,age,body mass index,hypertension,hyperlipidemia,triglyceride and high-density lipoprotein cholesterol(HDL-C)between the stable group and the vulnerable group(P>0.05).The levels of fasting blood glucose,HbA1c,total cholesterol,low-density lipoprotein cholesterol(LDL-C),LP-PLA2 and MMP-9 in the vulnerable group were(6.19±0.88)mmol/L,(10.21±1.16)%,(4.87±0.87)mmol/L,(2.90±0.45)mmol/L,(363.16±52.78)pg/L and(83.36±11.29)pg/L,respectively.They were significantly higher than those in the stable group[(5.81±0.44)mmol/L,(9.71±1.21)%,(4.51±0.55)mmol/L,(2.44±0.33)mmol/L,(292.44±47.27)pg/L,(60.46±9.85)pg/L],the differences were statistically significant(P<0.05).Only LP-PLA2 and MMP-9 were identified as independent factors affecting carotid plaque vulnerability in patients with type 2 diabetes mellitus complicated with cerebral infarction(P<0.05).HbA1c,LP-PLA2 and MMP-9 alone and in combination showed high accuracy in predicting carotid plaque vulnerability(P<0.05).Conclusion Patients with diabetes type 2 complicated with cerebral infarction have a higher risk of unstable plaque in the carotid artery.The combined application of LP-PLA2 and MMP-9 as markers show a better prediction effect for carotid artery unstable plaque.