UCH-L1、Lp-PLA2、Hcy与ACI患者颈动脉斑块形成的关系及联合检测价值  

Relationship between UCH-L 1,Lp-PLA 2,and Homocysteine levels and carotid plaque formation,and the value of their combined detection in patients with acute cerebral infarction

作　　者：王琳 李影[1] 杨海华 赵性泉 WANG Lin;LI Ying;YANG Haihua;ZHAO Xingquan(Department of Neurology,Daxing Teaching Hospital,Capital Medical University,Beijing 102600;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070;China Clinical Research Center for Neurological Diseases,Capital Medical University,Beijing 100070;Artificial Intelligence Research Center for Cerebrovascular Disease,Chinese Academy of Medical Sciences,Beijing 100010,China)

机构地区：[1]首都医科大学大兴教学医院神经内科,北京102600 [2]首都医科大学附属北京天坛医院神经内科,北京100070 [3]首都医科大学中国神经疾病临床研究中心,北京100070 [4]中国医学科学院脑血管病人工智能研究中心,北京100010

出　　处：《临床与病理杂志》2024年第10期1368-1377,共10页Journal of Clinical and Pathological Research

摘　　要：目的:急性脑梗死(acute cerebral infarction,ACI)患者短期预后不良率高达41%,故早期预测ACI短期预后对临床治疗方案的调整及出院后干预方案的制订至关重要。而颈动脉斑块是颈动脉粥样硬化的重要表现,且易继发血栓,导致管腔狭窄,现被证实可参与ACI发病及预后,探讨颈动脉斑块形成影响因素对早期识别及防治ACI、改善预后十分重要。基于此,本研究探讨血清泛素羧基末端水解酶L1(ubiquitin carboxyl terminal hydrolase L1,UCHL1)、脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)、同型半胱氨酸(homocysteine,Hcy)水平与ACI患者颈动脉斑块形成的关系,并一步探究上述指标联合检测对ACI患者短期预后的预测价值。方法:选取2021年11月至2023年11月首都医科大学大兴教学医院诊治的ACI患者187例,根据颈动脉超声检查结果将患者分为有斑块组(106例)、无斑块组(81例)。比较2组一般资料及血清UCH-L1、Hcy、Lp-PLA2水平,分析颈动脉斑块的影响因素。采用改良Rankin评分(modified Rankin score,mRS)评估患者随访90 d的预后,分析短期预后影响因素,通过受试者操作特征(receiver operator characteristic,ROC)曲线评估血清UCH-L1、Hcy、Lp-PLA2预测短期预后的价值。结果:有斑块组血清低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、UCH-L1、Hcy、LpPLA2水平及高血压病史比例均高于无斑块组,血清高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)水平低于无斑块组,差异均有统计学意义(均P<0.05)。单因素Logistic回归分析显示:UCH-L1(OR=1.104,95%CI1.065~1.145)、Hcy(OR=1.4,95%CI 1.214~1.690)、Lp-PLA2(OR=1.406,95%CI 1.129~1.752)是ACI患者颈动脉斑块的独立危险因素(均P<0.05)。随访90 d后,187例ACI患者失访2例,最终纳入预后研究的患者共185例。经mRS评估,预后不良者42(22.70%)例,预后良好者143(77.30%)例。预后不良组患者血清UCH-L1、Hcy、Lp-PLObjective:The short-term poor prognosis rate in acute cerebral infarction(ACI)patients is as high as 41%,making early prediction of short-term outcomes crucial for tailoring clinical treatments and post-discharge interventions.Carotid plaque formation,a key manifestation of carotid atherosclerosis,is prone to thrombosis and subsequent luminal narrowing,and has been confirmed to contribute to the pathogenesis and prognosis of ACI.This study investigates the association between serum ubiquitin carboxyl terminal hydrolase L 1(UCH-L 1),lipoprotein-associated phospholipase A 2(Lp-PLA 2),and homocysteine(Hcy)levels and carotid plaque formation in ACI patients,and further evaluates the predictive value of their combined detection for short-term prognosis.Methods:A total of 187 patients treated at the Daxing Teaching Hospital of Capital Medical University between November 2021 and November 2023 were enrolled.Based on carotid ultrasound results,patients were divided into a plaque group(106 cases)and a no plaque group(81 cases).General clinical data and serum levels of UCH-L 1,Hcy,and Lp PLA 2 were compared between the 2 groups to analyze factors influencing carotid plaque formation.The modified Rankin score(mRS)was used to evaluate prognosis at a 90-day follow-up,and univariate and multivariate Logistic regression analyses were conducted to identify factors affecting short-term outcomes.Receiver operator characteristic(ROC)curve analysis was used to assess the predictive value of serum UCH-L 1,Hcy,and Lp PLA 2 levels for short-term prognosis.Results:The plaque group had significantly higher levels of low-density lipoprotein cholesterol(LDL-C),UCH-L 1,Hcy,and Lp-PLA 2,as well as a higher prevalence of hypertension,compared to the non-plaque group,while high-density lipoprotein cholesterol(HDL-C)levels were significantly lower(all P<0.05).Univariate Logistic regression showed that UCH-L 1(OR=1.104,95%CI 1.065 to 1.145),Hcy(OR=1.4,95%CI 1.214 to 1.690),and Lp-PLA 2(OR=1.406,95%CI 1.129 to 1.752)were independent risk factors

关 键 词：急性脑梗死 颈动脉斑块 短期预后 泛素羧基末端水解酶L1 同型半胱氨酸 脂蛋白相关磷脂酶A2 

分 类 号：R74[医药卫生—神经病学与精神病学]