脂蛋白相关磷脂酶A2对腔隙性脑梗死患者早期神经功能恶化的预测作用  

Lipoprotein-associated phospholipase A2 predicts early neurological deterioration in patients with lacunar infarction

作　　者：张浩江[1] 钱明月[1] 葛中林[1] 于善花[1] Zhang Haojiang;Qian Mingyue;Ge Zhonglin;Yu Shanhua(Department ofNeurology,the Second People's Hospital of Lianyungang,Lianyungang,Jiangsu 222000,China)

机构地区：[1]江苏省连云港市第二人民医院神经内科,222000

出　　处：《中国脑血管病杂志》2019年第4期181-186,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：江苏大学医学临床科技发展基金(JLY20160174)

摘　　要：目的研究脂蛋白相关磷脂酶A2(Lp-PLA2)对腔隙性脑梗死患者发生早期神经功能恶化(END)的预测价值。方法回顾性连续纳入2016年1月至2018年7月于连云港市第二人民医院神经内科首次发病住院的急性腔隙性脑梗死患者281例。根据患者是否发生END分为END组(75例)和非END组(206例),比较两组患者的一般资料(年龄、性别、体质量指数、既往病史)、临床资料[美国国立卫生研究院卒中量表(NIHSS)评分、发病至入院时间、影像学资料(脑白质病变评分、脑微出血评分及分支动脉粥样硬化病)、治疗方法以及实验室检查结果如中性粒细胞与淋巴细胞比值(NLR)、总胆固醇、低密度脂蛋白胆固醇、空腹血糖、超敏C反应蛋白、血同型半胱氨酸及LpPLA2等]。采用免疫比浊法测定血中Lp-PLA2水平。应用SPSS 22. 0软件分析处理数据,采用多因素Logistic回归分析影响腔隙性脑梗死患者发生END的危险因素,采用受试者工作特征(ROC)曲线分析Lp-PLA2预测腔隙性脑梗死发生END的价值。结果单因素分析结果显示,END组NLR(2. 5±0. 5比2. 3±0. 5,t=2. 996)、低密度脂蛋白胆固醇[(2. 6±0. 8) mmol/L比(2. 3±0. 7) mmol/L,t=3. 056]、入院NIHSS评分[(3. 4±1. 5)分比(3. 0±1. 4)分,t=2. 080]和分支动脉粥样硬化病患者比例[21. 3%(16/75)比7. 3%(15/206),χ~2=11. 061]高于非END组,Lp-PLA2水平高于非END组[(240±26)μg/L比(180±23)μg/L,t=9. 032],差异均有统计学意义(均P <0. 05)。多因素Logistic回归分析结果显示,NLR升高(OR=3. 927,95%CI:2. 918～5. 016,P=0. 020)、血Lp-PLA2水平升高(OR=1. 026,95%CI:1. 019～1. 034,P <0. 01)、血中低密度脂蛋白胆固醇水平升高(OR=2. 715,95%CI:2. 193～3. 273,P=0. 025)、分支动脉粥样硬化病(OR=4. 552,95%CI:2. 934～7. 017,P=0. 002)和入院NIHSS评分升高(OR=2. 831,95%CI:2. 412～3. 197,P=0. 028)为腔隙性脑梗死发生END的独立危险因素。ROC曲线分析结果显示,LpPLA2预测END的曲线下面积�Objective To study the predictive value of lipoprotein-associated phospholipase A2 (Lp-PLA2) for early neurological deterioration (END) in patients with lacunar infarction.Methods Between January 2016 and July 2018,281 consecutive patients with first-ever acute lacunar infarction admitted to the Department of Neurology,the Second People's Hospital of Lianyungang were enrolled retrospectively.They were divided into END group ( n =75) and non- END group ( n =206) depending on whether END occurred or not.The general data (age,sex,body mass index,past medical history),clinical data (National Institute of Health stroke scale [NIHSS score]),onset to admission time,imaging data (white matter lesion score,cerebral microhemorrhage score and branch atherosclerosis), treatment methods and laboratory findings such as neutrophil to lymphocyte ratio,total cholesterol,low-density lipoprotein cholesterol,fasting blood glucose,hypersensitive C-reactive protein,homocysteine,and Lp-PLA2 were compared in patients between the two groups.Immunoturbidimetry was used to determine the level of Lp-PLA2 in blood.SPSS 22.0 software was used to analyze and process the data.Multivariate logistic regression was used to analyze the risk factors for affecting the occurrence of END in patients with lacunar cerebral infarction.Receiver operating characteristic (ROC) curve was used to analyze the value of Lp-PLA2 in predicting the occurrence of END in lacunar infarction.Results Univariate analysis showed that NLR (2.5±0.5 vs .2.3±0.5,t =2.996),low- density lipoprotein cholesterol (2.6±0.8 mmol/L vs .2.3±0.7 mmol/L,t =3.056),NIHSS score on admission (3.4±1.5 vs .3.0±1.4,t =2.080),and the proportion of patients with branch atherosclerosis (21.3%[16/75] vs .7.3%[15/206],χ^2=11.061) in the END group were higher than those in the non-END group (240±26 μg/L vs .180± 23 μg/L,t = 9.032),and the difference was statistically significant (all P <0.05).Multivariate logistic regression analysis showed that the increased level of NLR ( OR,3.927,95% CI

关 键 词：脂蛋白相关磷脂酶A2 腔隙性脑梗死 早期神经功能恶化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]