血清载脂蛋白A1和脂蛋白残粒浓度与慢性脑缺血患者颈动脉斑块形成关系分析  

Analysis of relationship between serum apolipoprotein A1 and lipoprotein remnant concentrations and carotid plaque formation in patients with chronic cerebral insufficiency

作　　者：刘静 刘冉 赵连锋 LIU Jing;LIU Ran;ZHAO Lian-feng(Department of Geriatrics,Henan Veterans Hospital,Xinxiang,Henan 453000,China;Department of Neurology,Xinxiang Longhua Hospital,Xinxiang,Henan 453000,China)

机构地区：[1]河南省荣军医院老年医学科,河南新乡453000 [2]新乡龙华医院神经内科,河南新乡453000

出　　处：《医药论坛杂志》2025年第3期328-332,337,共6页Journal of Medical Forum

摘　　要：目的探讨慢性脑缺血(chronic cerebral hypoperfusion,CCH)患者血清载脂蛋白A1(apolipoprotein A1,ApoA1)和脂蛋白残粒(remnant-like lipoprotein particles,RLP)的表达及联合检测在CCH患者颈动脉斑块形成中的关系。方法选择2019年12月-2023年12月河南省荣军医院收治的150例CCH患者纳入CCH组,另选择同期来院健康体检者160例纳入正常对照组,检测所有受试对象的血清Apo A1及RLP水平。采用彩色多普勒超声诊断仪检查CCH患者颈动脉斑块情况,根据检查结果将其分为无斑块组(60例)及斑块组(90例)。收集相关临床资料及实验室指标,采用logistic回归分析影响CCH患者发生颈动脉斑块的相关因素。采用受试者工作特征曲线(ROC)分析血清Apo A1及RLP对CCH患者发生颈动脉斑块的预测价值。结果CCH组患者血清Apo A1较正常对照组更低,差异有统计学意义(P<0.05),RLP较正常对照组更高,差异有统计学意义(P<0.05);单因素分析结果显示,斑块组舒张压、收缩压、RLP、总胆固醇(total cholesterol,TC)及低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)水平较无斑块组更高,差异有统计学意义(P<0.05),斑块组Apo A1水平较无斑块组更低,差异有统计学意义(P<0.05);经logistic多因素回归分析结果显示,血清Apo A1、RLP、TC及LDL-C均可作为CCH患者发生颈动脉斑块的影响因素(P<0.05);ROC曲线结果显示,血清Apo A1、RLP及TC、LDL-C联合预测CCH患者发生颈动脉斑块的灵敏度、特异度、准确度及曲线下面积AUC(0.95CI)分别为0.856、0.867、0.860、0.860(0.739~0.981),均高于各单一指标预测。结论血清Apo A1在CCH患者体内为低表达,RLP为高表达,二者均是影响CCH患者发生颈动脉斑块的因素,且Apo A1、RLP等指标联合预测CCH患者发生颈动脉斑块的价值更高,临床监测上述两种指标的变化,对预防颈动脉斑块形成具有较好的参考价值。Objective To investigate the serum level of apolipoprotein A1 in patients with chronic cerebral hypoperfusion(CCH).The expression of Apo A1 and remnant like lipoprotein particles(RLP)and their relationship with carotid plaque formation in patients with CCH.Methods Totally 150 CCH patients admitted to the hospital from December 2019 to December 2023 were selected to be included in the CCH group,and 160 healthy individuals who came to the hospital for physical examination during the same period were selected to be included in the normal control group,and the serum Apo A1 and RLP levels of all subjects were detected.The carotid plaques of CCH patients were examined by color Doppler ultrasonography.According to the examination results,they were divided into no plaque group(60 cases)and plaque group(90 cases).Relevant clinical data and laboratory indicators were collected,and logistic regression was used to analyze the related factors affecting the occurrence of carotid plaques in CCH patients.Predictive value of serum Apo A1 and RLP for carotid plaque in CCH patients using receiver operating characteristic(ROC)curve.Results The serum Apo A1 in the CCH group was lower than that in the normal control group(P<0.05),and the RLP was higher than that in the normal control group(P<0.05).Univariate analysis showed that the levels of diastolic blood pressure,systolic blood pressure,RLP,TC and LDL-C in the plaque group were higher than those in the non-plaque group(P<0.05),and the Apo A1 level in the plaque group was lower than that in the non-plaque group(P<0.05);logistic multivariate regression analysis showed that serum Apo A1,RLP,TC and LDL-C could be the influencing factors of carotid plaque in CCH patients(P<0.05).ROC curve results showed that the sensitivity,specificity,accuracy and AUC(0.95CI)of serum Apo A1,RLP,TC and LDL-C in predicting the occurrence of carotid plaque in CCH patients were 0.856,0.867,0.860 and 0.860(0.739-0.981),respectively.All of them are higher than the forecast of each single indicator.Conclusio

关 键 词：慢性脑供血不足 载脂蛋白A1 脂蛋白残粒 颈动脉斑块 

分 类 号：R543[医药卫生—心血管疾病]