急性脑梗死患者单核细胞/高密度脂蛋白比值与颅内动脉斑块稳定性的相关性分析  

Monocyte to high density lipoprotein ratio and stability of intracranial artery plaque in acute cerebral infarction patients:correlation analysis

作　　者：林煌斌 王诺 吴涛[1] LIN Huang-bin;WANG Nuo;WU Tao(Neurovascular Center,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai200433,China)

机构地区：[1]海军军医大学(第二军医大学)第一附属医院脑血管病中心,上海200433

出　　处：《海军军医大学学报》2022年第5期497-505,共9页Academic Journal of Naval Medical University

摘　　要：目的检测急性脑梗死患者的单核细胞/高密度脂蛋白比值(MHR),分析责任血管的斑块特征,并探讨MHR与斑块稳定性的相关性。方法回顾性连续纳入2019年1月至2020年7月于我院脑血管病中心住院治疗且行高分辨率磁共振(HRMR)颅内动脉管壁成像检查的急性脑梗死患者147例,其中无斑块组27例、单支血管病变组72例、多支血管病变组48例。采用HRMR颅内动脉管壁成像评估颅内动脉的狭窄程度和斑块稳定性。采用Spearman相关性分析探究MHR与斑块强化程度的相关性。以斑块的强化程度作为反映斑块稳定性的标准(0级强化为稳定斑块,1、2级强化为不稳定斑块),利用二分类logistic回归分析评估颅内动脉斑块稳定性的影响因素,通过ROC曲线分析MHR对斑块稳定性的评估价值,并根据约登指数计算最佳临界值及相应的灵敏度和特异度。根据MHR最佳临界值将有斑块患者分为高MHR组和低MHR组,通过随访(中位随访时间12.00个月)获得斑块强化程度的变化数据,构建Cox回归方程,探究MHR对颅内动脉斑块稳定性的预测作用。结果单支血管病变组及多支血管病变组的MHR均高于无斑块组(P=0.003、P<0.001),多支血管病变组的MHR高于单支血管病变组(P=0.003)。Spearman相关性分析显示,MHR与斑块强化程度呈正相关(r=0.469,P=0.001)。二分类logistic回归分析显示,在调整年龄、高血压病史、责任血管狭窄程度、血管重构方向、斑块负荷等因素后,MHR是急性脑梗死患者颅内动脉斑块稳定性的影响因素(OR=2.13,95%CI 1.45~3.14,P<0.001)。ROC曲线分析显示,MHR评估急性脑梗死患者颅内动脉斑块稳定性的AUC值为0.821(95%CI 0.726~0.915,P=0.001),最佳临界值为0.52×10^(9)/mmol,灵敏度为0.75,特异度为0.80。高MHR(MHR≥0.52×10^(9)/mmol)组患者44例,低MHR(MHR<0.52×10^(9)/mmol)组76例,高MHR组患者的斑块强化程度高于低MHR组(P=0.009)。Cox回归分析显示,低MHR与责任血管Objective To examine the monocyte to high density lipoprotein ratio(MHR)in patients with acute cerebral infarction,analyze the plaque characteristics of culprit arteries,and explore the correlation between MHR and plaque stability.Methods A total of 147 consecutive patients with acute cerebral infarction who were hospitalized in Neurovascular Center of The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from Jan.2019 to Jul.2020 and underwent intracranial high resolution magnetic resonance(HRMR)vessel wall imaging were retrospectively enrolled,with 27 cases in non-plaque group,72 cases in mono-diseased artery group,and 48 cases in multi-diseased artery group.The intracranial artery stenosis and plaque stability were evaluated by intracranial HMHR vessel wall imaging.The correlation between MHR and plaque enhancement was explored by Spearman correlation analysis.With plaque enhancement grade used for reflecting plaque stability(grade 0 enhancement was stable,and grade 1 and 2 enhancement was unstable),the influencing factors of intracranial arterial plaque stability were evaluated by binary logistic regression analysis.The evaluation value of MHR on plaque stability was analyzed by receiver operating characteristic(ROC)curve,and the optimal cut-off value and corresponding sensitivity and specificity were calculated according to Youden index.The patients with plaques were divided into high MHR group and low MHR group according to the optimal cut-off value of MHR.The data change of plaque enhancement was obtained during 12.00-month(median)follow-up,and Cox regression equation was constructed to explore the role of MHR in predicting the stability of intracranial arterial plaques.Results The MHR was significantly higher in the mono-diseased artery group and multi-diseased artery group than that in the non-plaque group(P=0.003,P<0.001),and was significantly higher in the multi-diseased artery group than that in the mono-diseased artery group(P=0.003).Spearman correlation analysi

关 键 词：急性脑梗死 单核细胞/高密度脂蛋白比值 斑块稳定性 颅内动脉 高分辨率血管壁磁共振成像 

分 类 号：R743.33[医药卫生—神经病学与精神病学]