血清Hcy、LPPLA2、PTX3水平与H型高血压患者发生急性脑梗死的关联性  

Correlation between serum Hcy,LPPLA2,PTX3 levels and acute cerebral infarction in patients with H-type hypertension

作　　者：车景华 王楠[1] 那里 史宝和[1] 刘彤彤[1] Che Jinghua;Wang Nan;Na Li;Shi Baohe;Liu Tongtong(Department of Neurology, Liaoning Provincial People's Hospital,Liaoning Province,Shenyang 110016, China)

机构地区：[1]辽宁省人民医院神经内科,沈阳110016

出　　处：《疑难病杂志》2021年第7期658-663,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：辽宁省科学技术计划项目(2020-ms-051)。

摘　　要：目的探讨血清同型半胱氨酸(Hcy)、脂蛋白相关磷脂酶A2(LPPLA2)、正五聚蛋白3(PTX3)水平与H型高血压患者发生急性脑梗死(ACI)的预测价值。方法回顾性分析2017年1月—2020年6月就诊于辽宁省人民医院的H型高血压患者80例,根据患者是否发生ACI分为ACI组27例和对照组53例。记录患者性别、年龄、体质量指数(BMI)、收缩压、舒张压、吸烟史、饮酒史、高血压家族史、是否合并糖尿病、高血脂等一般资料;测量血脂[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]和血清Hcy、LPPLA2、PTX3水平。采用多因素Logistic回归分析H型高血压患者发生ACI的危险因素;绘制受试者工作特征曲线(ROC)评估血清Hcy、LPPLA2、PTX3水平对预测H型高血压患者发生ACI的效能。结果ACI组BMI>24 kg/m2、合并糖尿病比例,收缩压、舒张压、血清LDL-C、Hcy、LPPLA2、PTX3高于对照组(χ^(2)/P=5.236/0.022,4.549/0.033;t/P=2.902/0.005,2.411/0.018,2.390/0.019,9.790/0.000,4.960/0.000,2.801/0.000)。Logistic回归分析显示,合并糖尿病、高收缩压、高LDL-C水平、高Hcy水平、高LPPLA2水平及高PTX3水平均为影响H型高血压患者发生ACI的独立危险因素[OR(95%CI)=3.364(1.081~10.463),1.214(1.071~1.376),2.273(1.238~4.173),3.108(1.743~5.541),1.883(1.318~2.690),2.337(1.281~4.266)]。ROC曲线显示,血清Hcy、LPPLA2、PTX3预测H型高血压患者发生ACI的截断值分别为18.89μmol/L、157.90μg/L、7.81μg/L,AUC分别为0.836、0.795、0.819,三者联合预测的AUC为0.913,高于三者单独预测(P<0.05)。结论影响H型高血压患者发生ACI的因素包括合并糖尿病、高收缩压及高LDL-C、Hcy、LPPLA2和PTX3水平,且血清Hcy、LPPLA2、PTX3水平对H型高血压患者发生ACI具有较高的预测价值。Objective To explore the predictive value of serum homocysteine(Hcy),lipoprotein-related phospholipase A2(LPPLA2),pentraxin 3(PTX3)levels and acute cerebral infarction(ACI)in patients with H-type hypertension.Methods A retrospective analysis of 80 patients with H-type hypertension who were admitted to Liaoning Provincial People's Hospital from January 2017 to June 2020.According to whether the patients had ACI,they were divided into 27 cases in the ACI group and 53 cases in the control group.Record the patient's gender,age,body mass index(BMI),systolic blood pressure,diastolic blood pressure,smoking history,drinking history,family history of hypertension,whether they have diabetes,hyperlipidemia and other general information.Measure blood lipids[total cholesterol(TC),triacylglycerol(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)]and serum Hcy,LPPLA2,and PTX3 levels.Multivariate Logistic regression was used to analyze the risk factors of ACI in patients with H-type hypertension.A receiver operating characteristic curve(ROC)was drawn to evaluate the efficacy of serum Hcy,LPPLA2,and PTX3 levels in predicting the occurrence of ACI in patients with H-type hypertension.Results BMI>24 kg/m2,the proportion of diabetes in the ACI group,systolic blood pressure,diastolic blood pressure,serum LDL-C,Hcy,LPPLA2,and PTX3 were higher than those in the control group(χ^(2)/P=5.236/0.022,4.549/0.033;t/P=2.902/0.005,2.411/0.018,2.390/0.019,9.790/0.000,4.960/0.000,2.801/0.000).Logistic regression analysis showed that diabetes,high systolic blood pressure,high LDL-C level,high Hcy level,high LPPLA2 level,and high PTX3 level are all independent risk factors affecting ACI in patients with H-type hypertension[OR(95%CI)=3.364(1.081-10.463),1.214(1.071-1.376),2.273(1.238-4.173),3.108(1.743-5.541),1.883(1.318-2.690),2.337(1.281-4.266)].The ROC curve showed that the cut-off values of serum Hcy,LPPLA2,and PTX3 for predicting the occurrence of ACI in patients with H-type hypertension were 18.89μmol

关 键 词：H型高血压 脑梗死 急性 同型半胱氨酸 脂蛋白相关磷脂酶A2 正五聚蛋白3 

分 类 号：R544.1[医药卫生—心血管疾病] R743.33[医药卫生—内科学]