老年脑卒中患者颅内动脉粥样斑块性质与Lp-PLA2水平的相关性

Association of intracranial atherosclerotic plaques with lipoprotein-related phospholipase A2 in elderly stroke patients

摘要:

目的 分析脂蛋白相关磷脂酶A2(Lp-PLA2)水平与颅内动脉粥样斑块性质的相关性,探讨Lp-PLA2能否成为预测老年脑卒中患者颅内动脉粥样斑块性质的临床标志物。方法 选取2017年1月至2019年12月在重庆市璧山区中医院神经内科诊断为缺血性脑卒中老年患者184例,行头颈CT血管(CTA)造影,其中大脑中动脉或基底动脉中重度狭窄(≥50%)患者102例为试验组,CTA正常患者82例为对照组。试验组行高分辨率磁共振(HRMRI)检查,按斑块性质将试验组分为不稳定斑块组(52例)和稳定斑块组(50例)；根据斑块来源的目标血管是否为神经症状体征的责任血管分为责任血管组(48例)和非责任血管组(54例)。收集所有患者一般临床资料,并通过酶联免疫吸附试验检测血清Lp-PLA2水平。采用SPSS 20.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ²检验。 结果 与对照组相比,试验组Lp-PLA2水平显著增高[(198.1±59.85)和(130.22±59.35)ng/ml,P<0.05]；与稳定斑块组相比,不稳定斑块组Lp-PLA2水平显著增高[(227.32±45.89)和(172.29±47.97)ng/ml,P<0.05]。责任血管组与非责任血管组Lp-PLA2水平差异无统计学意义[(208.27±36.58)和(211.54±57.18)ng/ml,P>0.05]。在责任血管组或非责任血管组中,稳定斑块组与非稳定斑块组Lp-PLA2水平差异均无统计学意义[责任血管组:(210.92±54.01)和(212.67±91.06)ng/ml,P>0.05；非责任血管组:(207.58±65.23)和(209.36±50.36)ng/ml,P>0.05]。结论 基于HRMRI 明确老年卒中患者颅内动脉粥样硬化斑块性质的基础上,血清Lp-PLA2水平与颅内动脉粥样硬化斑块的稳定性与易损性密切相关,未来可能成为评估颅内动脉粥样硬化斑块稳定性与易损性的重要标志物。

Abstract:

Objective To analyze the relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) and intracranial arterial atherosclerotic plaques in order to investigate whether Lp-PLA2 can be a clinical marker for predicting the properties of the plaques for the elderly with stroke. Methods A total of 184 elderly patients with ischemic stroke diagnosed in our hospital from January 2017 to December 2019 were enrolled in this study. According to the results of head and neck CT angiography (CTA), 102 of them with moderate or severe middle cerebral artery or basilar artery stenosis (≥50%) were assigned into the experimental group, and the other 82 with normal CTA results into the control group. High-resolution MRI (HRMRI) examination was performed for the patients from the experimental group, and then they were divided into unstable plaque subgroup (n=52) and stable plaque group (n=50). Based on whether the target blood vessel of the plaque source was a responsible blood vessel for neurological symptoms, they were also assigned into responsible vascular subgroup (n=48) and non-responsible vascular subgroup (n=54). The general clinical data of all patients were collected, and the serum Lp-PLA2 level was measured by enzyme-linked immunosorbent assay (ELISA). SPSS statistics 20.0 was used for statistical analysis. Data comparison between two groups was perfomed using t test or χ² test depending on data type. Results The Lp-PLA2 level was significantly higher in the experimental group than the control group [(198.1±59.85) vs (130.22±59.35) ng/ml, P<0.05], and in the unstable plaque subgroup than the stable plaque subgroup [(227.32±45.89) vs (172.29±47.97) ng/ml, P<0.05]. But there was no statistical difference in the level between the responsible vascular subgroup and non-responsible vascular subgroup [(208.27±36.58) vs (211.54±57.18) ng/ml, P>0.05]. In the patients from the responsible vascular subgroup, no obvious difference was seen in the level between those with stable and those with unstable plaques [(210.92±54.01) vs (212.67±91.06) ng/ml, P>0.05]. Similar result was observed in the patients with stable and those with unstable plaques from the non-responsible vascular subgroup [(207.58±65.23) vs (209.36±50.36) ng/ml, P>0.05]. Conclusion Based on the characteristics of intracranial atherosclerotic plaques identified by HRMRI, serum Lp-PLA2 level is closely associated with the stability and vulnerability of the plaques, and may be regarded as an important marker in assessment of the stability and vulnerability of plaques in the future.