血浆脂蛋白磷脂酶A2与脑梗死严重程度及预后的相关性研究  

Correlation between plasma lipoprotein-associated phospholipase A2 and severity and prognosis of acute cerebral infarction

作　　者：钱小燕[1] 王万华[1] 鲍治诚[1] 陆丽芸[1] 张蕾[1] 唐晴[1] 缪桂华[1] 王红洲[1] 张炎[1] QIAN Xiaoyan;WANG Wanhua;BAO Zhicheng;LU Liyun;ZHANG Lei;TANG Qing;MIAO Guihua;WANG Hongzhou;ZHANG Yan(Department of Neurology,Kunshan Hospital Affiliated of Jiangsu University,Kunshan 215300,China)

机构地区：[1]江苏大学附属昆山医院,江苏昆山215300

出　　处：《中国实用神经疾病杂志》2020年第5期374-379,共6页Chinese Journal of Practical Nervous Diseases

基　　金：昆山市社会发展科技专项(编号:KS1665)。

摘　　要：目的探讨血浆脂蛋白磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)水平与急性脑梗死(acute cerebral infarction,ACI)患者病情严重程度及预后的相关性。方法选取2017—2019年江苏大学附属昆山医院神经内科住院的207例急性脑梗死患者,检测Lp-PLA2及高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、脂蛋白aLP(a)、同型半胱氨酸水平(Hcy),详细记录患者有无高血压史、糖尿病史、吸烟、饮酒史。采用美国国立卫生研究所卒中量表评分(NIHSS)评估脑梗死严重程度,通过患者3个月的改良Rankin量表(mRS)评分评估其短期预后,分析LP-PLA2水平与脑梗死严重程度与预后的相关性。结果Lp-PLA2(OR=1.016,95%CI1.011~1.021,P<0.01)、LDL(OR=1.574,95%CI1.137~2.178,P=0.006)、Hcy(OR=1.044,95%CI1.008~1.082,P=0.017)、年龄(OR=1.071,95%CI1.041~1.101,P<0.01)、吸烟(OR=0.256,95%CI0.139~0.471,P<0.01)为脑梗死患者病情严重程度的独立危险因素,性别、饮酒、高血压史、糖尿病史、HDL、LP(a)则差异无统计学意义(P>0.05)。Lp-PLA2(OR=1.03,95%CI0.986~1.067,P<0.01)、吸烟(OR=0.397,95%CI0.16~0.984,P=0.046)、脑梗死病情的严重程度(OR=0.04,95%CI0.009~0.167,P<0.01)是影响脑梗死预后的独立危险因素。结论除传统的吸烟、LDL、Hcy、年龄危险因素外,Lp-PLA2亦是影响脑梗死患者病情严重程度的独立危险因素,且影响脑梗死患者的预后。Lp-PLA2或可作为标志物用于预测脑梗死病情严重程度及预后。Objective To investigate the correlation between the levels of plasma lipoprotein-associated phospholipase A2(Lp-PLA2)and severity of disease and prognosis in patients with acute cerebral infarction(ACI).Methods 207 patients with ACI were enrolled in our hospital from 2017 to 2019.We testet for Lp-PLA2 and high-density lipoprotein(HDL),low-density lipoprotein(LDL),lipoprotein a(LP(a)),and homo-cysteine level(Hcy),and record whether the patients had a history of hypertension,diabetes,smoking and alcohol consumption.We used the National Institutes of Health stroke scale(NIHSS)to assess the severity of cerebral infarction.There-month modified Rankin scale(mRS)was used to evaluate the short-term stroke outcomes.And favorable functional outcome was defined as MRS score≤2.We examined the relationship between the level of Lp-PLA2 and the severity of cerebral infarction and the prognosis in patients with ACI.Results Lp-PLA2(OR=1.016,95%CI1.011-1.021,P<0.01),LDL(OR=1.574,95%CI1.137-2.178,P=0.006),Hcy(OR=1.044,95%CI1.008-1.082,P=0.017),age(OR=1.071,95%CI1.041-1.101,P<0.01)and smoking(OR=0.256,95%CI0.139-0.471,P<0.01)were independent risk factors for severity of disease in patients with ACI.There were no statistically significant differences in gender,alcohol consumption,history of hypertension,history of diabetes,HDL,and LP(a)(P>0.05).Lp-PLA2(OR=1.03,95%CI0.986-1.067,P<0.01),smoking(OR=0.397,95%CI0.16-0.984,P=0.046)and severity of cerebral infarction(OR=0.04,95%CI0.009-0.167,P<0.01)were independent risk factors for the prognosis in patients with ACI.Conclusion Besides the traditional smoking,LDL,Hcy and age risk factors,Lp-PLA2 is also an independent risk factor for ACI patients.Lp-PLA2 increases significantly with the severity of the disease,and affects the prognosis of patients with cerebral infarction.Lp-PLA2 may be used as a marker to diagnose quickly and predict the severity and prognosis of early cerebral infarction.

关 键 词：脑梗死 严重程度 LP-PLA2 相关性 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]