老年急性脑梗死患者Hcy ApoB/ApoAⅠ及动态动脉硬化指数与颈动脉斑块性质的关系分析

Relationship between Hcy ApoB/ApoAⅠand Ambulatory Arterial Stiffness Index and Carotid Plaque Properties in Elderly Patients with Acute Cerebral Infarction

目的:观察老年急性脑梗死(ACI)患者同型半胱氨酸(Hcy)、载脂蛋白B(ApoB)/载脂蛋白AⅠ(ApoAⅠ)及动态动脉硬化指数(AASI)的变化与颈动脉斑块性质的关系。方法:纳入2021年7月至2023年7月本院收治的老年ACI患者103例(稳定性斑块61例,不稳定斑块42例),观察患者Hcy、ApoB/ApoAⅠ及AASI水平,采用单因素分析和多因素Logistic回归分析Hcy、ApoB、ApoAⅠ、AASI与颈动脉斑块性质的关系,并绘制受试者工作特征曲线(ROC)分析三指标对颈动脉斑块性质的评估效能。结果:不稳定斑块组Hcy、ApoB/ApoAⅠ、AASI水平及颈动脉中膜厚度(IMT)明显高于稳定斑块组,差异有统计学意义(P<0.05);Pearson相关性显示:Hcy、ApoB/ApoAⅠ、AASI水平与IMT成正相关,相关性有统计学意义(r=0.354、0.372、0.390,P<0.05);单因素分析显示:合并高血压、糖尿病、高脂血症与颈动脉斑块性质相关,差异有统计学意义(P<0.05);多因素Logistic回归分析显示:合并高血压、糖尿病、高脂血症及Hcy、ApoB/ApoAⅠ、AASI水平是影响颈动脉斑块性质的危险因素,差异有统计学意义(P<0.05);ROC分析显示:Hcy、ApoB/ApoAⅠ、AASI评估颈动脉斑块性质的AUC为0.696、0.711、0.764,三指标联合评估的AUC最高为0.853,最大约登指数下的敏感度和特异度分别为0.952、0.607。结论:老年ACI患者Hcy、ApoB/ApoAⅠ、AASI水平变化与颈动脉斑块性质存在一定的关联,且对不稳定性斑块具有一定的评估价值。

Objective:To observe the relationship between changes of homocysteine(Hcy),apolipoprotein B(ApoB)/apolipoprotein AⅠ(ApoAⅠ)and ambulatory arterial stiffness index(AASI)and carotid plaque properties in elderly patients with acute cerebral infarction(ACI).Methods:A total of 103 elderly patients with ACI(61 cases of stable plaque and 42 cases of unstable plaque)admitted to hospital from July 2021 to July 2023 were included.The Hcy,ApoB/ApoAⅠand AASI were observed.The relationship between Hcy,ApoB,ApoAⅠ,AASI and carotid plaque properties was analyzed by univariate analysis and multivariate Logistic regression analysis,and receiver operating characteristic curve(ROC)was plotted to analyze the evaluated efficiency of the three indicators on carotid plaque properties.Results:The Hcy,ApoB/ApoAⅠ,AASI and carotid intima-media thickness(IMT)in unstable plaque group were significantly higher than those in stable plaque group(P<0.05).Pearson correlation showed that Hcy,ApoB/ApoAⅠand AASI were positively correlated with IMT,showing statistical significance(r=0.354,0.372,0.390,P<0.05).Univariate analysis suggested that hypertension,diabetes mellitus and hyperlipidemia were related to the carotid plaque properties(P<0.05).Multivariate Logistic regression analysis revealed that hypertension,diabetes mellitus,hyperlipidemia,Hcy,ApoB/ApoAⅠ,and AASI were risk factors affecting the carotid plaque properties(P<0.05).ROC analysis showed that the AUCs of Hcy,ApoB/ApoAⅠand AASI in evaluating the carotid plaque properties were 0.696,0.711 and 0.764 respectively.The AUC of the combined evaluation of the three indicators was the highest(0.853),and the sensitivity and specificity under the maximum Youden index were 0.952 and 0.607 respectively.Conclusion:The changes of Hcy,ApoB/ApoAⅠand AASI in elderly patients with ACI are related to the carotid plaque properties,and have certain evaluated value on unstable plaque.