脂蛋白相关磷脂酶A_2和C反应蛋白与短暂性脑缺血发作患者风险分层的研究  

Role of lipoprotein-related phospholipase A_2 and hs-CRP in risk stratification of patients with transient ischemic attack

作　　者：赵振强[1] 胡兰[2] 蔡美华[1] 陈志斌[1] 王淑荣[1] 王埮[1] 陈小武[1] 

机构地区：[1]海南医学院附属医院神经内科,海口570102 [2]海南医学院附属医院检验科,海口570102

出　　处：《中华老年心脑血管病杂志》2015年第4期365-368,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：海南省自然科学基金(811217);海南省重大科技项目(ZDZX2013003);海南医学院科研培育基金(HY2010-025)

摘　　要：目的明确脂蛋白相关磷脂酶A2（Lp-PLA2）和高敏C反应蛋白（hs-CRP）是否有助于改善短暂性脑缺血发作（TIA）患者风险分层,提高预后预测能力。方法选择急诊入院的132例TIA患者,分为阳性事件组34例和阴性事件组98例。2组均进行ABCD2评分,0~3分为低危患者46例,4~5分为中危患者70例,6~7分为高危患者16例。检测Lp-PLA2含量、活性及hs-CRP水平。主要结局采用复合终点分析,90d内脑卒中或死亡及与症状相关≥50%大动脉狭窄或有心源性栓子需要抗凝治疗。结果与阴性事件组比较,阳性事件组Lp-PLA2含量和活性明显升高（P〈0.05）。有大动脉硬化者Lp-PLA2含量和活性较无大动脉硬化者明显升高（P〈0.05）。ABCD24~5分[RR=2.18,95%CI：1.26~3.61,P=0.008];ABCD2评分6~7分[RR=3.43,95%CI：1.91~6.39,P=0.001]Lp-PLA2活性〉33μmol/（L·min）[RR=2.73,95%CI：1.04~7.06,P=0.042]是TIA患者复合终点事件的预测因素。结论 Lp-PLA2检测和ABCD2评分法结合可提高TIA患者90d内发生脑卒中或死亡的预测能力。Objective To study whether lipoprotein-related phospholipase A2 and hs-CRP can improve the risk stratification and outcome in transient ischemic attack（TIA）patients.MethodsOne hundred and thirty-two TIA patients admitted to our hospital were divided into positive event group（n=34）and negative event group（n=98）.The patients were scored according to the ABCD2 and further divided into low risk group with 0-3ABCD2 scores（n=46）,moderate risk group with 4-5ABCD2 scores（n=70）and high risk group with 6-7ABCD2 scores（n=16）.Their serum Lp-PLA2 actiity and hs-CRP level were measured.Their primary outcomes were analyzed by composite endpoint analysis.The incidence of ischemic stroke or death within 90 days was calculated in patients with their conducting artery stenosis≥50% or cardiogenic embolism needing anticoagulation treatment.Results The serum Lp-PLA2 activity was significantly higher in positive event group than in negative event group and in patients with their conducting artery stenosis≥50%than in those with no conducting artery stenosis（P〈0.05）.Composite endpoint analysis showed that 4-5ABCD2 scores,6-7ABCD2 scores,and Lp-PLA2activity〉33μmol/（L·min）were the risk factors for composite end events in TIA patients（RR=2.18,95%CI：1.26-3.61,P =0.008;RR =3.43,95%CI：1.91-6.39,P =0.001;RR =2.73,95%CI：1.04-7.06,P=0.042）.Conclusion Lp-PLA2 activity in combination with ABCD2 score can predict ischemic stroke and death within 90 days in TIA patients.

关 键 词：脂蛋白类 磷脂酶A2 C反应蛋白质 脑缺血发作 短暂性 卒中 抗凝药 

分 类 号：R743.3[医药卫生—神经病学与精神病学]