血浆ApoA1/ApoB比值对短暂性脑缺血发作后早期脑梗死的影响及预测价值

Effect and predictive value of plasma ApoA1/ApoB ratio on early cerebral infarction after transient ischemic attack

目的:探讨血浆载脂蛋白A1(ApoA1)/载脂蛋白B(ApoB)比值对短暂性脑缺血发作(TIA)后早期脑梗死的影响及预测价值。方法:回顾性收集2018年9月~2021年5月在华北理工大学附属医院神经内科或急诊科住院治疗的147例TIA患者。根据7 d内是否发生脑梗死将患者分为脑梗死组(65例)和无脑梗死组(82例)。采用免疫比浊法检测血浆ApoA1、ApoB水平,计算ApoA1/ApoB比值;采用ROC曲线分析血浆ApoA1/ApoB比值对TIA后早期脑梗死的预测价值;采用Logistic回归分析TIA后早期脑梗死的影响因素。结果:与无脑梗死组比较,脑梗死组高脂血症史(52.44%比69.23%)、脑卒中史(36.59%比55.38%)、颅内动脉狭窄(21.95%比38.46%)及脑缺血持续时间≥30min比例(51.22%比73.85%)、甘油三酯[(1.27±0.48)mmol/L比(1.65±0.53)mmol/L]、空腹血糖[(5.43±1.52)mmol/L比(6.05±1.65)mmol/L]水平显著升高(P<0.05或<0.01);血浆ApoA1水平[(1.35±0.32)g/L比(1.07±0.30)g/L]及ApoA1/ApoB比值[(1.52±0.34)比(1.03±0.31)]显著降低,ApoB水平[(0.85±0.23)g/L比(1.04±0.27)g/L]显著升高(P均<0.001)。血浆ApoA1/ApoB比值预测TIA后早期脑梗死的敏感度为86.15%,特异性为82.93%,曲线下面积为0.884(95%CI 0.821~0.931,P<0.001),截断值为1.33。多因素Logistic回归分析显示,高脂血症、脑卒中史、颅内动脉狭窄、空腹血糖>6.1 mmol/L、脑缺血持续时间>30 min为TIA后早期脑梗死的独立危险因素(OR=1.128~6.613,P<0.05或<0.01),而ApoA1/ApoB比值>1.33是其独立保护因素(OR=0.005,P<0.001)。结论:TIA后脑梗死患者血浆中ApoA1/ApoB比值显著降低,其是影响TIA后早期脑梗死的因素,且对TIA后早期脑梗死有一定预测价值。

Objective:To investigate the effect and predictive value of plasma apolipoprotein A1(ApoA1)/apolipoprotein B(ApoB)ratio on early cerebral infarction(CI)after transient ischemic attack(TIA).Methods:A total of 147 TIA patients who were hospitalized in the Neurology or Emergency Department of Affiliated Hospital of North China University of Science and Technology from September 2018 to May 2021 were retrospectively collected.According to presence of cerebral infarction within 7d,they were divided into CI group(n=65)and no CI group(n=82).Immunoturbidimetry was used to detect plasma ApoA1 and ApoB levels,then ApoA1/ApoB ratio was calculated;ROC curve was used to analyze the predictive value of plasma ApoA1/ApoB ratio for early CI after TIA;Logistic regression was used to analyze influencing factors of early CI after TIA.Results:Compared with no CI group,CI group had significantly higher proportions of hyperlipidemia history(52.44%vs.69.23%),stroke history(36.59%vs.55.38%),intracranial artery stenosis(21.95%vs.38.46%)and cerebral ischemia duration≥30min(51.22%vs.73.85%),levels of triglyceride[(1.27±0.48)mmol/L vs.(1.65±0.53)mmol/L]and fasting blood glucose[FBG:(5.43±1.52)mmol/L vs.(6.05±1.65)mmol/L](P<0.05 or<0.01);significant lower plasma ApoA1 level[(1.35±0.32)g/L vs.(1.07±0.30)g/L]and ApoA1/ApoB ratio[(1.52±0.34)vs.(1.03±0.31)]and significant higher ApoB level[(0.85±0.23)g/L vs.(1.04±0.27)g/L](P<0.001 all).Sensitivity and specificity of plasma ApoA1/ApoB ratio predicting early CI after TIA was 86.15%and 82.93%respectively,the area under the curve was 0.884(95%CI 0.821~0.931,P<0.001)and cutoff value was 1.33.Multivariate Logistic regression analysis suggested that hyperlipidemia,stroke history,intracranial artery stenosis,FBG>6.1 mmol/L and cerebral ischemia duration>30min were independent risk factors for early CI after TIA(OR=1.128~6.613,P<0.05 or<0.01),while ApoA1/ApoB ratio>1.33 was its independent protective factor(OR=0.005,P<0.001).Conclusion:Plasma ApoA1/ApoB ratio significantly decreases in patients with cerebral infarction after TIA,which is a factor affecting early cerebral infarction after TIA,and it has certain predictive value for it.