入院血清Lp-PLA2水平预测短暂性脑缺血发作后早期卒中风险  

Serum Lp-PLA2 level on admission for predicting early stroke risk after transient ischemic attack

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

机构地区：[1]连云港市第二人民医院神经内科,连云港222000

出　　处：《国际医药卫生导报》2022年第4期475-479,共5页International Medicine and Health Guidance News

基　　金：江苏大学临床科技发展基金(JLY20160174)。

摘　　要：目的探讨入院血清脂蛋白相关磷脂酶A2(Lp-PLA2)预测短暂性脑缺血发作(TIA)后早期卒中发生风险的价值。方法回顾性连续收集2015年8月至2019年11月在连云港市第二人民医院神经内科住院的TIA患者179例,其中男100例,女79例,年龄(66.2±7.8)岁。根据TIA发病后90 d随访是否发生卒中分为卒中组28例和非卒中组151例。多变量logistic回归分析确定卒中发生的独立危险因素,进一步采用受试者工作特征曲线(ROC)分析Lp-PLA2预测卒中发生的价值。符合正态分布的计量资料组间比较采用独立样本t检验,不符合正态分布的计量资料组间比较采用Mann-Whitney U检验,计数资料组间比较采用χ^(2)检验或Fisher精确检验。结果卒中组患者基线收缩压、血清Lp-PLA2水平、症状持续时间≥60 min比例、ABCD2评分、血管狭窄率、不稳定斑块率分别为(158.4±27.4)mmHg(1 mmHg=0.133 kPa)、(286.5±18.9)μg/L、39.2%(11/28)、6.00(5.00,6.00)分、78.6%(22/28)、78.6%(22/28),均高于非卒中组(146.3±25.2)mmHg、(230.5±17.2)μg/L、13.2%(20/151)、4.00(3.00,5.00)分、36.4%(55/151)、38.4%(58/151),而双抗血小板使用率为60.0%(15/28),低于非卒中组83.3%(115/151),差异均有统计学意义(均P<0.05)。调整混杂因素后多变量logistic回归分析显示基线收缩压、LP-PLA2、症状持续时间≥60 min、ABCD2评分、血管狭窄、不稳定斑块为卒中发生的独立危险因素(均OR>1),双抗血小板治疗为卒中发生的保护性因素(OR<1)。Lp-PLA2预测早期卒中的曲线下面积为0.752(95%CI:0.657~0.848;Z=5.142,P<0.001),最佳截断值为212.6μg/L,灵敏度为85.66%,特异度为52.67%。结论Lp-PLA2是TIA患者出现早期卒中发生的独立危险因素,且对早期卒中的发生有一定的预测价值。Objective To investigate the predictive value of serum lipoprotein-associated phospholipase A2(Lp-PLA2)level on admission for early stroke risk after transient ischemic attack(TIA).Methods A total of 179 TIA patients were retrospectively enrolled in Department of Neurology,The Second People's Hospital of Lianyungang from August 2015 to November 2019,including 100 males and 79 females,aged(66.2±7.8)years.TIA patients were divided into a stroke group(28 cases)and a non-stroke group(151 cases)after 3 months of follow up.Multivariate logistic regression analysis was used to identify the independent risk factors for stroke.The receiver operating characteristic curve(ROC)was used to analyze the predictive value of Lp-PLA2 for stroke risk after TIA.Independent sample t test was used for inter-group comparison of the measurement data conforming to normal distribution,Mann-Whitney U test was used for inter-group comparison of the measurement data conforming to abnormal distribution,andχ^(2) test or Fisher's exact test was used for inter-group comparison of the count data.Results The baseline systolic blood pressure,serum LP-PLA2 level,proportion of duration of symptom≥60 min,ABCD2 score,vascular stenosis rate,and unstable plaque rate in the stroke group were(158.4±27.4)mmHg(1 mmHg=0.133 kPa),(286.5±18.9)μg/L,39.2%(11/28),6.00(5.00,6.00)points,78.6%(22/28),and 78.6%(22/28),higher than those in the non-stroke group[(146.3±25.2)mmHg,(230.5±17.2)μg/L,13.2%(20/151),4.00(3.00,5.00)points,36.4%(55/151),and 38.4%(58/151)],and the usage rate of dual antiplatelet drugs was 60.0%(15/28),lower than that in the non-stroke group[83.3%(115/151)],with statistically significant differences(all P<0.05).After adjusting for confounders,multivariate logistic regression analysis showed that baseline systolic blood pressure,LP-PLA2,duration of symptoms≥60 min,ABCD2 score,vascular stenosis,and unstable plaque were independent risk factors for stroke(all OR>1),and dual antiplatelet therapy was a protective factor for stroke(OR<1).The

关 键 词：脂蛋白相关磷脂酶A2 短暂性脑缺血发作 早期卒中风险 

分 类 号：R743.31[医药卫生—神经病学与精神病学]