血小板内皮细胞黏附分子1联合血清脂蛋白相关磷脂酶A2对颈动脉粥样硬化斑块稳定性的诊断价值  

Diagnostic Value of Platelet Endothelial Cell Adhesion Molecule-1 Combined with Serum Lipoprotein-associated Phospholipase A2 in Evaluating the Stability of Carotid Atherosclerotic Plaque

作　　者：黄利强 程道宾[1] 叶子明[1] 胡瑞婷[2] 周梦晓 秦超[1] HUANG Liqiang;CHENG Daobin;YE Ziming;HU Ruiting;ZHOU Mengxiao;QIN Chao(Department of Neurology,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Neurology,Guangxi Zhuang Autonomous Region People's Hospital,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院神经内科,广西南宁市530021 [2]广西壮族自治区民族医院神经内科,广西南宁市530021

出　　处：《中国全科医学》2021年第2期170-175,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(81860222)——MIAT调控神经元Beclin-1和Caspase-3加重脑缺血再灌注损伤的机制;广西科技计划项目(609167348026)——经颅直流电刺激通过胆碱能通路保护恒河猴脑梗死缺血半暗带的机制。

摘　　要：背景颈动脉粥样硬化斑块的脱落及破裂出血是诱发急性脑卒中的独立危险因素,但是关于颈动脉粥样硬化斑块的稳定性尚缺乏定量的评估指标。目的探究血小板内皮细胞黏附分子1(PECAM-l/CD31)联合血清脂蛋白相关磷脂酶A2(Lp-PLA2)对颈动脉粥样硬化斑块稳定性的诊断价值。方法选择2017年10月-2019年3月广西医科大学第一附属医院神经内科收治颈动脉粥样硬化斑块患者139例作为研究对象,根据超声造影检查结果,分为不稳定斑块组(76例)和稳定斑块组(63例),记录两组患者的性别、年龄、体质指数(BMI)、吸烟、饮酒、高血压、心房颤动情况,并检测其空腹血糖、白细胞计数、红细胞计数、中性粒细胞计数、血小板计数、血肌酐、尿酸、纤维蛋白原、超敏C反应蛋白、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、PECAM-1/CD31、Lp-PLA2水平。采用多因素Logistics回归分析筛选出影响颈动脉粥样硬化斑块稳定性的独立危险因素,建立各指标的受试者工作特征(ROC)曲线,评估各指标及联合指标对颈动脉不稳定斑块的诊断效能。结果不稳定斑块组吸烟比例、心房颤动比例及超敏C反应蛋白、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、PECAM-1/CD31、Lp-PLA2水平高于稳定斑块组(P<0.05)。多因素Logistic回归分析结果显示,低密度脂蛋白〔OR=2.453,95%CI(2.322,2.591)〕、PECAM-1/CD31〔OR=1.372,95%CI(1.166,1.614)〕和Lp-PLA2〔OR=1.827,95%CI(1.565,2.133)〕是颈动脉不稳定斑块发生的影响因素(P<0.05)。PECAM-1/CD31(r=0.090,P=0.031)、Lp-PLA2(r=0.090,P=0.005)与低密度脂蛋白呈正相关。PECAM-1/CD31诊断颈动脉粥样硬化斑块稳定性的ROC曲线下面积(AUC)为0.686〔95%CI(0.224,0.405)〕,最佳诊断点为11.050 mg/L,灵敏度为77.60%,特异度为60.30%;Lp-PLA2的AUC为0.724〔95%C(I 0.189,0.364)〕,最佳诊断点为176.585 mg/L,其灵敏度为98.70%,特异度为47.60%;Background The shedding and rupture of carotid atherosclerotic plaques are independent risk factors for acute stroke,but the stability of carotid atherosclerotic plaques lacks quantitative evaluation indicators.Objective To explore the diagnostic value of platelet endothelial cell adhesion molecule-1(PECAM-1/CD31)combined with serum lipoprotein-associated phospholipase A2(Lp-PLA2)in evaluating the stability of carotid atherosclerotic plaque.Methods 139 patients with carotid atherosclerosis plaque admitted to Department of Neurology,the First Affiliated Hospital of Guangxi Medical University from October 2017 to March 2019 were enrolled,including 76 with unstable plaques and 63 with stable plaques detected by contrastenhanced ultrasound.Gender,age,BMI,smoking,drinking,hypertension and atrial fibrillation prevalence,fasting plasma glucose(FPG),serum white blood count(WBC),red blood count(RBC),neutrophil count,platelet,creatinine,uric acid,fibrinogen,high-sensitivity C-reactive protein(hs-CRP),total cholesterol,triacylglycerol,high-density lipoprotein,low-density lipoprotein and Lp-PLA2,and PECAM-1/CD31were collected.The independent risk factors affecting the stability of carotid atherosclerotic plaque were screened out by multivariate Logistic regression analysis,and the ROC curve of the indicator,either alone or in combination,was established to evaluate the efficiency in evaluating the stability of carotid atherosclerotic plaque.Results The prevalence of smoking and atrial fibrillation,average levels of hs-CRP,total cholesterol,triacylglycerol,high-density lipoprotein,low-density lipoprotein,PECAM-1/CD31,and Lp-PLA2 in unstable plaque group were higher than those of stable plaque group(P<0.05).Multivariate Logistic regression analysis showed that lowdensity lipoprotein〔OR=2.453,95%CI(2.322,2.591)〕,PECAM-1/CD31〔OR=1.372,95%CI(1.166,1.614)〕and Lp-PLA2〔OR=1.827,95%CI(1.565,2.133)〕were associated with the occurrence of unstable carotid atherosclerotic plaques(P<0.05).PECAM-1/CD31(r=0.090,P=0.031)and Lp-PL

关 键 词：动脉粥样硬化 颈动脉粥样硬化斑块 血小板内皮细胞黏附分子1 脂蛋白相关磷脂酶A2 缺血性脑卒中 

分 类 号：R543.5[医药卫生—心血管疾病]