血浆Lp-PLA2、Hcy、Ang-1对TIA患者进展为急性脑梗死的预测价值

Predictive value of plasma Lp-PLA2,Hcy and Ang-1 on the progression of TIA patients to acute cerebral infarction

目的探讨血浆脂蛋白相关磷脂酶A2(Lp-PLA2)、同型半胱氨酸(Hcy)、血管生成素-1(Ang-1)对短暂性脑缺血发作(TIA)患者进展为急性脑梗死的预测价值。方法采用简单随机抽样法选取2020年1月至2023年12月中国人民解放军联勤保障部队第九八〇医院和河北医科大学第四医院收治的877例TIA患者作为研究组,并随机选取同期在两家医院体检的健康者877例作为对照组,采用酶联免疫吸附试验检测两组血浆Lp-PLA2、Hcy、Ang-1水平并比较。根据研究组患者发病后90 d内是否进展为急性脑梗死,将其分为进展组和未进展组,比较两组患者血浆Lp-PLA2、Hcy、Ang-1水平。采用多因素Logistic回归分析TIA患者进展为急性脑梗死的影响因素;绘制受试者工作特征(ROC)曲线分析Lp-PLA2、Hcy、Ang-1单项及3项联合对TIA患者进展为急性脑梗死的预测价值。结果研究组血浆Lp-PLA2、Hcy水平均高于对照组,而血浆Ang-1水平低于对照组,差异均有统计学意义(P<0.05)。877例TIA患者随访90 d后,有106例进展为急性脑梗死(进展组),771例未进展为急性脑梗死(未进展组),进展率为12.09%。进展组血浆Lp-PLA2、Hcy水平均高于未进展组,而血浆Ang-1水平低于未进展组,差异均有统计学意义(P<0.05)。进展组年龄≥60岁、合并高血压、合并糖尿病、大动脉粥样硬化型、TIA发作时间>30 min比例均高于未进展组(P<0.05)。多因素Logistic回归分析结果显示,年龄≥60岁、合并高血压、合并糖尿病、大动脉粥样硬化型、TIA发作时间>30 min及Lp-PLA2、Hcy水平升高均是TIA患者进展为急性脑梗死的危险因素(P<0.05),而Ang-1水平升高则是保护因素(P<0.05)。ROC曲线分析结果显示,血浆Lp-PLA2、Hcy、Ang-1联合预测TIA患者进展为急性脑梗死的灵敏度为95.28%,曲线下面积(AUC)为0.941,明显高于各指标单项预测的AUC(P<0.05)。结论血浆Lp-PLA2、Hcy、Ang-1水平在TIA患者中异常表达,三者均为TIA患者进展为急性脑梗死的影响因素,对TIA进展为急性脑梗死具有一定的预测价值,但三者联合预测价值更高。

Objective To investigate the predictive value of plasma lipoprotein-associated phospholipase A2(Lp-PLA2),homocysteine(Hcy)and angiopoietin-1(Ang-1)on the progression of acute cerebral infarction in patients with transient ischemic attack(TIA).Methods A total of 877 patients with TIA admitted to No.980 Hospital,Joint Service Support Force of the People′s Liberation Army and the Fourth Hospital of Hebei Medical University from January 2020 to December 2023 were selected as the study group by simple random sampling method,and 877 healthy people in the two hospitals in the same period were randomly selected as the control group;the plasma levels of Lp-PLA2,Hcy and Ang-1 were measured by enzyme linked immunosorbent assay and compared between the two groups.The patients with TIA in the study group were divided into progressive group and non-progressive group according to whether or not they developed into acute cerebral infarction within 90 days after onset of the disease,and the plasma levels of Lp-PLA2,Hcy and Ang-1 in the two groups were compared.The factors affecting the progression in patients with TIA to acute cerebral infarction were analyzed by multivariate Logistic regression analysis.The predictive value of Lp-PLA2,Hcy and Ang-1,alone or in combination,on the progression of TIA patients to acute cerebral infarction was analyzed by the receiver operating characteristic(ROC)curve.Results The plasma Lp-PLA2 and Hcy levels in the study group were higher than those in the control group,whereas plasma Ang-1 level was lower than that in the control group,and the differences were all statistically significant(P<0.05).After 90 d follow-up,among 877 patients with TIA,106 patients progressed to acute cerebral infarction(progressive group)and 771 patients did not progress to acute cerebral infarction(non-progressive group),with a progression rate of 12.09%.The plasma Lp-PLA2 and Hcy levels in the progressive group were higher than those in the non-progressive group,whereas plasma Ang-1 level was lower than that in the non-progressive group,and the differences were all statistically significant(P<0.05).The proportions of age≥60 years old,with hypertension,with diabetes mellitus,large artery atherosclerosis and TIA onset time>30 min in the progressive group were higher than those in the non-progressive group(P<0.05).Multivariate Logistic regression analysis results showed that age≥60 years,with hypertension,with diabetes mellitus,large artery atherosclerosis,TIA onset time>30 min and increased levels of Lp-PLA2 and Hcy were all risk factors for TIA patients to develop into acute cerebral infarction(P<0.05),and increased level of Ang-1 was a protective factor(P<0.05).The ROC curve analysis results showed that the sensitivity of the combination of plasma Lp-PLA2,Hcy and Ang-1 in predicting the progression to acute cerebral infarction in patients with TIA was 95.28%,and the area under the curve was 0.941,which was significantly higher than that of the individual prediction of each index(P<0.05).Conclusion The plasma levels of Lp-PLA2,Hcy and Ang-1 are abnormally expressed in patients with TIA,which are all factors influencing the progression of TIA to acute cerebral infarction,with certain predictive value for the progression of TIA to acute cerebral infarction,and the combination of the three indexes had a higher predictive value.