脂蛋白相关磷脂酶A2联合血尿酸对急性脑梗死并发血管性痴呆的预测价值

Predictive value of lipoprotein associated phospholipase A2 combined with serum uric acid in patients with acute cerebral infarction complicated with vascular dementia

目的探讨脂蛋白相关磷脂酶A2(Lp-PLA2)联合血尿酸对急性脑梗死并发血管性痴呆(VD)的预测价值。方法前瞻性选取哈尔滨医科大学附属第一医院收治的147例急性脑梗死住院患者,依据是否并发VD,分成VD组和无VD(nVD)组。比较2组人口学资料、临床相关资料和血清Lp-PLA2、血尿酸水平,多因素Logistic分析急性脑梗死患者并发VD的危险因素,利用受试者工作特征(ROC)曲线评价血清Lp-PLA2、血尿酸以及二者联合对急性脑梗死并发VD的预测价值。结果VD组年龄、高血压患病率、总胆固醇(TC)、Lp-PLA2[(192.38±40.16)μg/L比(148.27±35.02)μg/L]、血尿酸[(349.27±56.94)μmol/L比(293.50±48.26)μmol/L]均明显高于nVD组(P<0.05)。年龄(OR=2.017)、高血压(OR=1.381)、血清Lp-PLA2(OR=1.379)、血尿酸(OR=1.673)是急性脑梗死患者并发VD的独立危险因素(P<0.05)。血清Lp-PLA2、血尿酸预测急性脑梗死并发VD的曲线下面积(AUC)为0.785、0.734,界值为176.52μg/L、328.40μmol/L。二者联合预测的AUC为0.846(95%CI:0.737~0.955),明显高于血尿酸单独预测(P<0.05)。结论Lp-PLA2、血尿酸是急性脑梗死患者并发VD的危险因素,二者联合对急性脑梗死并发VD具有较好预测价值。

Objective To investigate the predictive value of lipoprotein related phospholipase A2(Lp-PLA2)combined with serum uric acid in acute cerebral infarction complicated with vascular dementia(VD).Methods Totally 147 patients with acute cerebral infarction admitted to the First Affiliated Hospital of Harbin(Medical University were prospectively selected and were divided into VD group and non nVD)group according to whether there was VD.Demographic data,clinical data,serum Lp-vascular dementia-PLA2 and blood uric acid levels were compared between the two groups.Multivariate Logistic analysis was conducted to analyze the risk factors of VD in patients with acute cerebral infarction,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum Lp-PLA2,serum uric acid,and their combination for VD in acute cerebral infarction.Results Age,prevalence of hypertension,total cholesterol(TC),Lp-PLA2(192.38±40.16 vs 148.27±35.02),blood uric acid(349.27±56.94 vs 293.50±48.26)in the VD group were significantly higher than those in the nVD group(P<0.05).Age(OR=2.017),hypertension(OR=1.381),serum Lp-PLA2(OR=1.379),and serum uric acid(OR=1.673)were independent risk factors for VD in patients with acute cerebral infarction(P<0.05).The area under the curve(AUC)of serum Lp-PLA2 and serum uric acid for predicting VD in acute cerebral infarction were 0.785 and 0.734,with cut-off values of 176.52μg/L and 328.40μmol/L,respectively.The AUC predicted by the combination of the two was 0.846(95%CI:0.737-0.955),which was significantly higher than that predicted by blood uric acid alone(P<0.05).Conclusion Lp-PLA2 and blood uric acid are risk factors for VD in patients with acute cerebral infarction,and the combination of the two has good predictive value for VD in patients with acute cerebral infarction.