Lp-PLA2、Hcy及D-D对ACI患者易损斑块及病情的评估价值

The Evaluation Value of Lp-PLA2,Hcy,and D-D for Vulnerable Plaques and Disease Severity in ACI Patients

目的探讨脂蛋白相关磷脂酶A2(Lp-PLA2)、同型半胱氨酸(Hcy)及D-二聚体(D-D)在急性脑梗死(ACI)患者易损斑块及病情的评估价值。方法选取2022年1月-2023年12月在信阳市中心医院诊治的100例ACI患者,按照颈动脉超声结果分为易损斑块组51例、稳定斑块组30例和无斑块组19例,按照脑梗死神经功能缺损严重程度分为轻度梗死组37例、中度梗死组41例和重度梗死组22例,比较各组血清Lp-PLA2、Hcy、D-D,并分析血清Lp-PLA2、Hcy、D-D对ACI患者颈动脉易损斑块的诊断价值,以及对病情的评估价值。结果相较无斑块组,稳定斑块组、易损斑块组血清Lp-PLA2、Hcy、D-D更高(P<0.05),相较于稳定斑块组,易损斑块组血清Lp-PLA2、Hcy、D-D更高(P<0.05)。联合=Lp-PLA2+(0.121/0.005)×Hcy+(0.016/0.005)×D-D,ROC曲线分析得出,血清Lp-PLA2、Hcy、D-D及三者联合诊断ACI患者颈动脉易损斑块的AUC分别为0.829、0.806、0.829、0.882,敏感度分别为60.8%、90.2%、96.1%、76.5%,特异度分别为91.8%、59.2%、63.3%、87.8%。相较于轻度梗死组,中度、重度梗死组血清Lp-PLA2、Hcy、D-D更高(P<0.05),相较于中度梗死组,重度梗死组血清Lp-PLA2、Hcy、D-D更高(P<0.05)。经Spearman分析,血清Lp-PLA2、Hcy、D-D与病情严重程度呈正相关(P<0.05)。结论血清Lp-PLA2、Hcy、D-D联合应用对ACI患者颈动脉易损斑块具有较高的诊断价值,且病情越严重,血清Lp-PLA2、Hcy、D-D水平越高。

Objective To explore the evaluation value of lipoprotein associated phospholipase A2(Lp-PLA2),homocysteine(Hcy),and D-dimer(D-D)levels in vulnerable plaques and condition of patients with acute cerebral infarction(ACI).Methods One hundred ACI patients diagnosed and treated in Xinyang City Central Hospital from January 2022 to December 2023 were selected and divided into 51 cases in vulnerable plaque group,30 cases in stable plaque group,and 19 cases in no-plaque group according to the carotid ultrasound results.According to the severity of neurological deficit in cerebral infarction,there were 37 cases in the mild infarction group,41 cases in the moderate infarction group and 22 cases in the severe infarction group.Serum Lp-PLA2,Hcy and D-D were compared among the groups and analyzed for the diagnostic value of serum Lp-PLA2,Hcy and D-D for carotid vulnerable plaques in patients with ACI as well as the assessment value of the condition.Result Compared to the non plaque group,the stable plaque group and vulnerable plaque group had higher serum Lp PLA2,Hcy,and D-D(P<0.05),while the vulnerable plaque group had higher serum Lp PLA2,Hcy,and D-D(P<0.05).Combined with Lp PLA2+(0.121/0.005)×Hcy+(0.016/0.005)×D-D,ROC curve analysis showed that the AUC of serum Lp PLA2,Hcy,D-D,and their combined diagnosis for vulnerable carotid plaques in ACI patients were 0.829,0.806,0.829,and 0.882,with sensitivity of 60.8%,90.2%,96.1%,and 76.5%,and specificity of 91.8%,59.2%,63.3%,and 87.8%,respectively.Compared to the mild infarction group,the serum levels of Lp PLA2,Hcy,and D-D were higher in the moderate and severe infarction groups(P<0.05),while the serum levels of Lp PLA2,Hcy,and D-D were higher in the severe infarction group(P<0.05).According to Spearman analysis,serum Lp PLA2,Hcy,and D-D were positively correlated with the severity of the disease(P<0.05).Conclusion The combination of serum Lp-PLA2,Hcy,and D-D has a high diagnostic value for carotid artery vulnerable plaque in patients with ACI,and the more severe the condition,the higher the serum Lp-PLA2,Hcy,and D-D levels.