阿司匹林抵抗和脂蛋白相关磷脂酶A2与复发性缺血性脑卒中的相关性分析  

Correlation analysis of aspirin resistance and lipoprotein-associated phospholipase A2 withrecurrent ischemic stroke

作　　者：刘庆杰[1] 杨璨宇 查文文 LIU Qingjie;YANG Canyu;ZHA Wenwen(The People’s Hospital of Yongcheng,Yongcheng 476600,China;The First Clinical Medical College of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]永城市人民医院,河南永城476600 [2]郑州大学第一临床医学院,河南郑州450052

出　　处：《中国实用神经疾病杂志》2025年第1期83-87,共5页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20230366)。

摘　　要：目的探讨非心源性卒中患者阿司匹林抵抗和脂蛋白相关磷脂酶A2(Lp-PLA2)与缺血性脑卒中复发的相关性。方法选取2021-10—2022-10在永城市人民医院住院的发病7 d内的急性非心源性缺血性脑卒中患者72例,基于临床病史和神经影像学证据分为初发组(n=36)和复发组(n=36),入院后规律服用阿司匹林7 d。采用血栓弹力图测定阿司匹林抵抗,并测定血清Lp-PLA2水平。比较初发组和复发组阿司匹林抵抗、Lp-PLA2水平,分析阿司匹林抵抗、Lp-PLA2与缺血性脑卒中复发之间的相关性。采用多元Logistic回归分析筛选复发性卒中独立危险因素,ROC曲线下面积评价相关危险因素的预测价值。结果36.1%的复发性卒中患者存在阿司匹林抵抗,19.4%的初发患者存在阿司匹林抵抗,2组比较差异有统计学意义(P<0.001)。复发性卒中患者血清PLA2水平中位数160.0μg/L,初次发病患者为125.0μg/L,2组比较差异有统计学意义(P=0.008)。多元Logistic回归分析显示阿司匹林抵抗和高PLA2水平是复发性缺血性脑卒中的影响因素,阿司匹林抵抗患者卒中复发风险增加4.06倍(P=0.042),高于Lp-PLA2中位值患者的4.37倍(P=0.011)。阿司匹林抵抗和Lp-PLA2预测卒中复发的ROC曲线下面积分别为0.753(95%CI:0.641~0.873)和0.683(95%CI:0.559~0.807)。结论与初发卒中患者相比,复发性卒中患者阿司匹林抵抗的比率和血清Lp-PLA2水平均明显升高,可作为复发性卒中的预测因素。Objective To investigate the relationship between aspirin resistance and Lp-PLA2 and recurrent ischemic stroke in non-cardioembolic stroke patients.Methods Seventy-two patients with acute non-cardiogenic ischemic stroke within 7 days of onset hospitalized in the People’s Hospital of Yongcheng from October 2021 to October 2022 were selected.Based on clinical history and neuroimaging evidence,the patients were divided into primary group(n=36)and recurrent group(n=36).After admission,the patients were regularly treated with aspirin for 7 days.Aspirin resistance was measured by thrombologram.Serum Lp-PLA2 levels were determined.Logistic regression analysis was used to screen out independent risk factor for recurrent ischemic stroke.The predictive value of risk factors was mearured by the area under the ROC curve.Results Aspirin resistance was found in 36.1%of patients with recurrent stroke,while in 19.4%of patients with initial stroke,with a statistically significant difference between the two groups(P<0.001).The median of serum Lp-PLA2 level in patients with recurrent stroke was 160.0μg/L,which was 125.0μg/L in patients with initial stroke,with a statistically significant difference between the two groups(P=0.008).Logistic regression analysis showed that aspirin resistance and high PLA2 levels were factors for recurrent ischemic stroke.Patients with aspirin resistance had a 4.06-fold increased risk of recurrent stroke(P=0.042),patients with higher Lp-PLA2 median value had a 4.37-fold increased risk of recurrent stroke(P=0.011).The area under the ROC curve for aspirin resistance and Lp-PLA2 in predicting recurrent stroke was 0.753 and 0.683,respectively,with 95%confidence intervals(0.641-0.873 and 0.559-0.807,respectively).Conclusion The ratio of aspirin resistance and serum Lp-PLA2 level in recurrent stroke patients are significantly higher than those in primary stroke patients,which can be used as risk predictors of stroke recurrence.

关 键 词：复发性缺血性脑卒中 阿司匹林抵抗 血栓弹力图 脂蛋白相关磷脂酶A2 血清 

分 类 号：R743.3[医药卫生—神经病学与精神病学]