血清CD40配体和脂蛋白相关磷脂酶A2水平与老年颈动脉斑块的关系  

Relationship of serum CD40L and Lp-PLA2 levels with carotid artery plaques in elderly ischemic stroke patients

作　　者：王琨[1] 侯国欣[1] 刘磊[1] 臧文举[1] 凌端强 王颍超 Wang Kun;Hou Guoxin;Liu Lei;Zang Wenju;Ling Duanqiang;Wang Yingchao(Department of Interventional Therapy,Zhengzhou People’s Hospital,Zhengzhou 450000,Henan Province,China)

机构地区：[1]郑州人民医院介入科,450000

出　　处：《中华老年心脑血管病杂志》2020年第7期739-743,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探究老年缺血性脑卒中患者血清CD40配体(CD40L)和脂蛋白相关磷脂酶A2(Lp-PLA2)水平与颈动脉斑块及短期预后的关系。方法收集2017年1月~2018年8月郑州人民医院血管内介入治疗的老年急性缺血性脑卒中患者180例,根据颈动脉内膜中层厚度(IMT)分为无斑块组60例,稳定斑块组52例和不稳定斑块组68例,检测血清CD40L、Lp-PLA2水平,至少随访1年,记录复发率。结果3组吸烟、高血压、糖尿病比例、TC、TG、LDL-C、CD40L、Lp-PLA2水平、术后1年复发率及累计复发率比较,有统计学差异(P<0.05,P<0.01)。血清CD40L、Lp-PLA2诊断颈动脉斑块的ROC曲线下面积(AUC)分别为0.799(95%CI:0.701~0.876)、0.824(95%CI:0.729~0.896);而血清CD40L、Lp-PLA2诊断不稳定斑块的AUC分别为0.695(95%CI:0.563~0.808)、0.676(95%CI:0.543~0.792)。高血压、高TC、高TG、高LDL-C、高CD40L及高Lp-PLA2是影响颈动脉粥样斑块形成的独立危险因素(P<0.05,P<0.01)。高TC、高LDL-C、高CD40L及高Lp-PLA2是不稳定斑块的独立危险因素(95%CI:1.053~8.177,P=0.040;95%CI:1.192~9.668,P=0.022;95%CI:1.407~9.608,P=0.008;95%CI:2.563~25.159,P=0.000)。Kaplan-Meier生存曲线显示,不稳定斑块组的无复发生存期明显低于稳定斑块组和无斑块组(P<0.01)。随访期间3组复发脑卒中患者血清CD40L、Lp-PLA2水平明显高于无复发患者(P<0.05)。结论血清CD40L和Lp-PLA2对急性脑缺血性脑卒中老年患者颈动脉粥样硬化斑块的稳定性及患者介入治疗的短期预后均具有一定的预测价值。Objective To study the relationship of serum CD40 L and Lp-PLA2 levels with carotid artery plaques and short-term outcome in elderly ischemic stroke patients.Methods One hundred and eighty ischemic stroke patients admitted to our hospital from January 2017 to August 2018 for endovascular intervention were divided into carotid artery plaque-free group(n=60),stable carotid artery plaque group(n=52)and unstable carotid artery plaque group(n=68)according to their ultrasonography.The serum CD40 L and Lp-PLA2 levels were measured in 3 groups.The patients were followed up for at least 1 year,during which the recurrence rate of ischemic stroke was recorded.Results The number of smokers,the incidence of hypertension and DM,the serum levels of TC,TG,LDL-C,CD40 L and Lp-PLA2 and recurrence rate were significantly different in 3 groups(P<0.05,P<0.01).The AUC for serum CD40 L and Lp-PLA2 in diagnosis of stable and unstable carotid artery plaques was 0.799 and 0.824,0.695 and 0.676 respectively(95%CI:0.701-0.876,95%CI:0.729-0.896,95%CI:0.563-0.808,95%CI:0.543-0.792).Hypertension,elevated serum levels of TC,TG,LDL-C,CD40 L and Lp-PLA2 were the independent risk factors for carotid atheroclerotic plaques(P<0.05,P<0.01)while elevated serum levels of LDL-C,CD40 L,TC and Lp-PLA2 were the independent risk factors for unstable carotid artery plaques(95%CI:1.053-8.177,P=0.040;95%CI:1.192-9.668,P=0.022;95%CI:1.407-9.608,P=0.008;95%CI:2.563-25.159,P=0.000).Kaplan-Meier survival curve analysis showed that the reccurrence-free survival time was significantly shorter in unstable carotid artery plaque group than in stable carotid artery plaque group and carotid artery plaque-free group(P<0.01).The serum CD40 L and Lp-PLA2 levels were significantly higher in recurrent cerebral stroke patients than in non-recurrent cerebral stroke patients(P<0.05).Conclusion Serum CD40 L and Lp-PLA2 levels can predict the stable carotid atherosclerotic plaques and short-term outcome in acute ischemic stroke patients after interventional therapy.

关 键 词：CD40配体 磷脂酶类A2 颈动脉狭窄 动脉粥样硬化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]