老年急性脑梗死患者血清高残余胆固醇水平与Lp-PLA2表达的相关性研究

林永娟; 蒋澄; 黄明敏; 李玲玲

doi:10.16766/j.cnki.issn.1674-4152.002576

老年急性脑梗死患者血清高残余胆固醇水平与Lp-PLA2表达的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.002576

南京大学医学院附属鼓楼医院老年科，江苏南京 210008

基金项目:

国家自然科学基金项目 81400965

江苏省干部保健科研课题 BJ18006

详细信息

通讯作者:
李玲玲, E-mail: seulilingling@126.com

中图分类号: R743.33
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- 被引次数: 0
出版历程
- 收稿日期: 2021-12-20
- 网络出版日期: 2022-09-26

Association of high residual cholesterol levels and Lp-PLA2 expression in elderly patients with acute ischemic stroke

Department of Geriatric, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China

摘要

摘要: 目的探讨老年急性脑梗死(AIS)患者残余胆固醇(RC)和脂蛋白相关磷脂酶A2(Lp-PLA2)的相关性，评估两者对AIS病情的预测价值。方法选取2019年1月—2021年3月南京大学医学院附属鼓楼医院收治的老年高RC-AIS患者162例(观察组)，另外选取同期正常RC-AIS患者165例(对照组)，比较2组间血脂指标和Lp-PLA2的差异，采用Pearson法分析相关性，采用ROC曲线评价两者对AIS病情的预测价值。结果观察组Lp-PLA2水平、治疗后美国国立卫生院卒中量表(NIHSS)评分高于对照组(Z=4.361、2.182，均P＜0.05)。Logistic回归分析示Lp-PLA2(95% CI：1.000~1.007，P=0.045)、治疗后NIHSS评分(95% CI：1.026~1.369，P=0.021)是AIS患者RC水平的独立影响因素。AIS患者RC、Lp-PLA2水平及治疗后NIHSS评分互呈正相关(r=0.683、0.635、0.640，均P＜0.001)。RC＞0.845 mmol/L、Lp-PLA2＞242 ng/mL预测AIS病情严重程度的ROC曲线下面积分别为0.835、0.854，2项指标联合评估的AUC为0.897。结论高RC-AIS患者血清Lp-PLA2水平显著升高，两者呈正相关，在预测AIS治疗后神经功能缺损程度和预后中具有良好价值。
- 急性脑梗死 /
- 残余胆固醇 /
- 脂蛋白相关磷脂酶A2 /
- 相关性研究
Abstract: Objective To investigate the correlation between residual cholesterol (RC) and lipoprotein-related phospholipase A2 (Lp-PLA2) and evaluated their predictive value in elderly patients with acute ischemic stroke (AIS) and high RC. Methods A total of 162 elderly AIS patients with high RC (observation group) admitted in Nanjing Drum Tower Hospital from Jan. 2019 to Mar. 2021 were included in the study, and 165 normal RC-AIS patients during the same period were selected as the control group. The levels of blood lipid parameters and Lp-PLA2 in the two groups were compared, and the correlation between RC and Lp-PLA2 were analysed by the Pearson method. ROC analysis was used to evaluate the predictive value of RC and Lp-PLA2 in neurological impairment. Results The levels of Lp-PLA2 and National Institute of Health stroke scale (NIHSS) score after treatment in the observation group were significantly higher than those in the control group (Z=4.361, 2.182, all P < 0.05). Logistic regression analysis showed that Lp-PLA2 (95% CI: 1.000-1.007, P=0.045) and NIHSS score after treatment (95% CI: 1.026-1.369, P=0.021) were independent factors of RC levels in patients with AIS. RC, Lp-PLA2 and NIHSS score after treatment in patients with AIS were positively correlated with each other (r=0.683, 0.635, 0.640, all P < 0.001). The area under the ROC curve for serum RC>0.845 mmol/L and Lp-PLA2>242 ng/mL in predicting the severity of AIS were 0.835 and 0.854, respectively. When combined with two indicators, the AUC was 0.897. Conclusion Lp-PLA2 levels were significantly increased in patients with high RC-AIS. A positive correlation was found between the levels of RC and Lp-PLA2. High levels of RC or Lp-PLA2 have a good value in predicting the degree of neurological impairment and the prognosis after treatment of patients with AIS.
- Acute ischemic stroke /
- Remnant cholesterol /
- Lipoprotein-associated phospholipase A2 /
- Correlation study

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图 1 不同浓度RC脑梗死患者血清Lp-PLA2、治疗后NIHSS评分比较

注：^aP＜0.05。

Figure 1. Comparison of serum Lp-PLA2 and NIHSS score in patients with RC cerebral infarction at different concentrations

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图 2 Lp-PLA2、RC对AIS病情严重程度诊断ROC曲线

Figure 2. ROC curve of Lp-PLA2 and RC in the diagnosis of severity of AIS

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表 1 2组脑梗死患者基线资料比较

Table 1. Comparison of baseline data of cerebral infarction patients between two groups

组别	例数	年龄(x±s，岁)	性别(例)		BMI(x±s)	吸烟史[例(%)]	高血压病史[例(%)]	糖尿病病史[例(%)]	冠心病病史[例(%)]	入院NIHSS评分[M(P₂₅, P₇₅), 分]	治疗后NIHSS评分[M(P₂₅, P₇₅), 分]
组别	例数	年龄(x±s，岁)	男性	女性	BMI(x±s)	吸烟史[例(%)]	高血压病史[例(%)]	糖尿病病史[例(%)]	冠心病病史[例(%)]	入院NIHSS评分[M(P₂₅, P₇₅), 分]	治疗后NIHSS评分[M(P₂₅, P₇₅), 分]
观察组	162	67.59±12.13	97	65	23.25±2.56	43(26.5)	123(75.9)	52(29.6)	22(13.6)	5.00(2.00, 11.00)	2.50(1.00, 8.00)
对照组	165	68.27±11.53	109	56	22.56±2.66	42(25.5)	113(68.5)	57(34.5)	21(12.7)	4.00(2.00, 8.00)	2.00(1.00, 4.00)
统计量		-0.521^a	-1.342^b		1.401^a	0.051^b	2.252^b	-0.911^b	0.050^b	1.404^c	2.182^c
P值		0.632	0.247		0.750	0.822	0.133	0.341	0.819	0.160	0.029
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 2组脑梗死患者实验室指标比较

Table 2. Comparison of laboratory indexes between two groups of cerebral infarction patients

组别	例数	糖化血红蛋白[M(P₂₅, P₇₅), %]	FPG [M(P₂₅, P₇₅), mmol/L]	TC [M(P₂₅, P₇₅), mmol/L]	TG [M(P₂₅, P₇₅), mmol/L]	HDL-C (x±s, mmol/L)
观察组	162	5.80(5.40, 6.50)	5.46(4.83, 6.87)	4.05(3.42, 4.90)	1.56(0.99, 2.29)	2.40±0.92
对照组	165	5.80(5.40, 6.85)	5.40(4.76, 6.49)	3.64(3.09, 4.32)	1.10(0.88, 1.40)	2.17±0.79
统计量		-0.111^a	1.651^a	4.271^a	7.190^a	2.460^b
P值		0.707	0.193	0.001	0.001	0.270

组别	例数	LDL-C[M(P₂₅, P₇₅), mmol/L]	Hcy[M(P₂₅, P₇₅), μmol/L]		CRP[M(P₂₅, P₇₅), g/L]	Lp-PLA2[M(P₂₅, P₇₅), ng/mL]
观察组	162	0.67(0.27, 0.87)	4.29(2.58, 8.43)		3.70(2.30, 8.20)	283.50(170.00, 393.00)
对照组	165	1.07(0.87, 1.25)	3.40(2.70, 7.70)		2.90(2.10, 6.20)	169.00(115.00, 356.00)
统计量		-10.497^a	3.850^a		2.590^a	4.361^a
P值		＜0.001	0.029		0.016	＜0.001
注：^a为Z值，^b为t值。

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表 3 AIS患者RC水平的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of RC level in AIS patients

变量	B	SE	Wald χ²	P值	OR值	95% CI
TC	1.548	0.270	32.771	＜0.001	4.701	2.767~7.986
TG	1.864	0.384	23.551	＜0.001	6.451	3.038~13.696
LDL-C	-7.880	1.058	55.472	＜0.001	0.000	0.000~0.003
Lp-PLA2	0.004	0.002	4.011	0.045	1.004	1.000~1.007
Hcy	0.026	0.036	0.553	0.457	1.027	0.958~1.101
CRP	0.006	0.009	0.491	0.483	1.006	0.989~1.023
入院基线NIHSS	-0.059	0.054	1.179	0.278	0.943	0.848~1.048
治疗后NIHSS	0.170	0.074	5.321	0.021	1.185	1.026~1.369

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表 4 Lp-PLA2、RC对AIS病情严重程度的预测价值

Table 4. Predictive value of Lp-PLA2 and RC in AIS

项目	最佳临界值	灵敏度(%)	特异度(%)	AUC	95% CI
Lp-PLA2(ng/mL)	242	92.2	68.0	0.854	0.814~0.894
RC(mmol/L)	0.845	81.4	73.8	0.835	0.790~0.880
两者联合		86.3	82.7	0.897	0.864~0.930

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