血清Hcy、sdLDL-C、Lp-PLA2水平对短暂性脑缺血发作进展为急性脑梗死的预测效能  

Predictive effect of serum Hcy,sdLDL-C,and Lp-PLA2 levels on the progression of transient ischemic attack to acute cerebral infarction

作　　者：李洪远[1] 董书宇 鹿寒冰[1] Li Hongyuan;Dong Shuyu;Lu Hanbing(Department of Neurology,Xuzhou Central Hospital,Xuzhou 221000,China)

机构地区：[1]徐州市中心医院神经内科,江苏徐州221000

出　　处：《中华脑血管病杂志（电子版）》2024年第1期40-48,共9页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

摘　　要：目的:分析血清同型半胱氨酸(Hcy)、小而密低密度脂蛋白胆固醇(sdLDL-C)、脂蛋白相关磷脂酶A2(Lp-PLA2)水平对短暂性脑缺血发作(TIA)进展为急性脑梗死的预测效能。方法:随机选取徐州市中心医院神经内科自2018年2月至2020年6月收治的223例TIA患者记为研究组,另随机选取同期健康体检者191例记为对照组。对研究组患者进行12个月的随访,将进展为急性脑梗死的TIA患者归为进展组,余者归为未进展组。采用秩和检验比较初诊时研究组与对照组以及进展组和未进展组血清Hcy、sdLDL-C、Lp-PLA2水平的差异;采用Logistic回归分析研究组随访12个月内进展为急性脑梗死的危险因素;绘制受试者工作特征(ROC)曲线,分析血清Hcy、sdLDL-C、Lp-PLA2对TIA进展为急性脑梗死的预测效能。结果:初诊时研究组血清Hcy、sdLDL-C、Lp-PLA2水平均高于对照组[(14.57(9.46,18.92)μmol/L vs 10.08(5.75,13.29)μmol/L、1.28(1.11,1.59)mmol/L vs 0.37(0.32,0.41)mmol/L、186.18(146.34,212.16)μg/L vs 132.53(77.34,159.05)μg/L],差异具有统计学意义(U=25.697、53.784、39.621,P均<0.001);研究组患者发病后12个月内进展为急性脑梗死的发生率为25.11%(55/219);进展组血清Hcy、sdLDL-C、Lp-PLA2水平均高于未进展组[20.86(13.43,23.85)μmol/L vs 13.79(11.86,15.57)μmol/L、2.63(1.41,3.26)mmol/L vs 1.23(1.06,1.40)mmol/L、216.84(185.40,239.45)μg/L vs 183.12(132.51,191.25)μg/L],差异具有统计学意义(U=14.596、30.089、22.047,P均<0.001);伴颈动脉斑块、伴脑动脉狭窄、伴心律失常、发作次数>3次、合并高血压病、合并糖尿病、合并高脂血症、吸烟史、饮酒史、血清Hcy水平、血清sdLDL-C水平、血清Lp-PLA2水平均是TIA患者进展为急性脑梗死的影响因素[比值比(OR)=4.116、3.414、2.622、3.180、2.863、2.633、2.998、2.073、2.002、4.216、4.693、4.371,P均<0.05];血清Hcy、sdLDL-C、Lp-PLA2水平预测TIA进展为急性脑梗死的最佳截断值分别为17.36μObjective To analyze the predictive effect of serum homocysteine(Hcy),small dense low density lipoprotein cholesterol(sdLDL-C)and lipoprotein associated phospholipase A2(Lp-PLA2)levels on the progression of transient ischemic attack(TIA)to acute cerebral infarction.Methods 223 patients with TIA admitted to the Neurology Department of Xuzhou Central Hospital from February 2018 to October 2020 were randomly included as the study group,and 191 healthy people in the same period were randomly included as the control group.The patients in the study group were followed up for 12 months,and the TIA patients who progressed to acute cerebral infarction were classified as the progression group,and the rest were classified as the non-progression group.The serum levels of Hcy,sdLDL-C,and Lp-PLA2 were compared between the study group at initial diagnosis and the control group,and between the progression group and non-progression group by rank test.The risk factors of developing acute cerebral infarction within 12 months follow up in the study group were analyzed by Logistic resgression.The receiver operating characteristic(ROC)curve was performed to explore the predictive efficacy of serum Hcy,sdLDL-C,and Lp-PLA2 on the progression of TIA to acute cerebral infarction.Results The serum Hcy,sdLDL-C,and Lp-PLA2 levels in the study group at initial diagnosis were higher than those in the control group[14.57(9.46,18.92)μmol/L vs 10.08(5.75,13.29)μmol/L,1.28(1.11,1.59)mmol/L vs 0.37(0.32,0.41)mmol/L,186.18(146.34,212.16)μg/L vs 132.53(77.34,159.05µg/L);U=25.697,53.784,39.621;all P<0.001)].The incidence of acute cerebral infarction was 25.11%(55/219)in the study group within 12 months follow up.The serum levels of Hcy,sdLDL-C,and Lp-PLA2 in the progression group were higher than those in the non-progression group[20.86(13.43,23.85)μmol/L vs 13.79(11.86,15.57)μmol/L,2.63(1.41,3.26)mmol/L vs 1.23(1.06,1.40)mmol/L,216.84(185.40,239.45)μg/L vs 183.12(132.51,191.25)μg/L;U=14.596,30.089,22.047;all P<0.001].Carotid artery plaque,cer

关 键 词：同型半胱氨酸 小而密低密度脂蛋白胆固醇 脂蛋白相关磷脂酶A2 短暂性脑缺血发作 急性脑梗死 

分 类 号：R743.31[医药卫生—神经病学与精神病学]