脂蛋白相关磷脂酶A2、颈动脉斑块内新生血管与颈动脉粥样硬化及缺血性脑卒中的相关性研究  

The association of Lipoprotein associated phospholipase A2,Carotid plaque neovascularization and carotid atherosclerosis as well as ischemic stroke

作　　者：田晔[1] 贾欢[1] 田晖[2] 魏敬美 于萍[1] 郭力[1] 李彬[1] TIAN Ye;JIA Huan;TIAN Hui(Department of Neurology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,河北省神经病学重点实验室,河北石家庄050000 [2]河北医科大学第二医院超声科,河北石家庄050000

出　　处：《中风与神经疾病杂志》2018年第11期989-995,共7页Journal of Apoplexy and Nervous Diseases

基　　金：河北省卫计委2017年度医学科学重点课题计划项目(20170097)

摘　　要：目的探究脂蛋白相关磷脂酶A2(Lipoprotein Associated Phospholipase A2,Lp-PLA2)、颈动脉斑块内新生血管与颈动脉粥样硬化及缺血性脑卒中的相关性。方法收集2016年12月～2017年12月于河北医科大学第二医院神经内科就诊的存在颈动脉粥样硬化斑块患者60例为病例组,健康体检者60例为对照组,应用增强免疫比浊法测定Lp-PLA2含量,病例组应用超声造影(Contrast-enhanced Ultrasonography,CEUS)检测颈动脉斑块内新生血管水平,根据影像学分为脑梗死与非脑梗死组。结果病例组和对照组Lp-PLA2水平差异有统计学意义(P <0. 05),Lp-PLA2是颈动脉粥样硬化斑块形成的危险因素(OR=1. 007,95%CI 1. 004～1. 011),但校正血脂等因素后相关性降低(OR=1. 004,95%CI 0. 999～1. 010)。脑梗死组与非脑梗死组颈动脉斑块内新生血管等级差异有统计学意义(P <0. 05),且新生血管III级与颈动脉粥样硬化患者发生脑梗死密切相关(OR=24,95%CI 1. 952～295. 061)。Lp-PLA2水平与缺血性脑卒中及颈动脉斑块内新生血管等级之间差异无统计学意义(P> 0. 05)。结论血清中Lp-PLA2水平是颈动脉粥样硬化斑块形成的危险因素,一定程度上受血脂等因素的影响。应用CEUS技术可以检测动脉粥样硬化斑块内的新生血管水平,新生血管等级与缺血性脑卒中存在相关性。其中新生血管III级是发生缺血性脑卒中的独立危险因素。尚未发现Lp-PLA2水平与缺血性脑卒中及颈动脉斑块内新生血管之间的相关性。Objective To investigate the association of Lp-PLA2,carotid plaque neovascularization and carotid atherosclerosis as well as ischemic stroke.Methods 60 patients with carotid atherosclerotic plaques admitted in the Second Hospital of Hebei Medical University,Department of Neurology were selected as case group,60 healthy examinees were regarded as control group.Serum Lp-PLA2 mass was tested by enhanced immunoturbidimentry.Carotid plaque neovascularization was detected by CEUS in case group and the case group was divided into cerebral infarction group and non-cerebral infarction group according to imageological examinations.Results There was significant difference of Lp-PLA2 level between case group and control group(P<0.05).Lp-PLA2 level was regarded as a risk factor for the development of carotid atherosclerotic plaques(OR=1.007,95%CI 1.004~1.011),however,the association attenuated after adjusted factors like LDL and HDL(OR=1.004,95%CI 0.999-1.010).There was significant difference between the grade of Carotid plaque neovascularization and incidence of cerebral infarction(P<0.05)and there was great association of grade III of neovascularization and cerebral infarction in patients with carotid atherosclerotic plaques(OR=24,95%CI 1.952~295.061).No significant differences were found between Lp-PLA2 level and cerebral infarction as well as Lp-PLA2 level and carotid plaque neovascularization(P>0.05).Conclusion Serum Lp-PLA2 level was regarded as a risk factor for he development of carotid atherosclerotic plaques,which was affected by other factors like LDL and HDL to some extent.The grade of neovascularization in atherosclerotic plaques detected by CEUS was associated with the occurrence of cerebral infarction.Grade III neovascularization was recognized as an independent risk factor for cerebral infarction.However,the associations between Lp-PLA2 level and cerebral infarction as well as Lp-PLA2 level and carotid plaque neovascularization were uncertain.

关 键 词：脂蛋白相关磷脂酶A2 超声造影 斑块内新生血管 颈动脉粥样硬化 缺血性脑卒中 

分 类 号：R743[医药卫生—神经病学与精神病学]