血清脂蛋白相关磷脂酶A2水平与颈动脉粥样硬化斑块的相关性分析

田雪; 黄柳; 姚菁青; 李云涛

doi:10.16766/j.cnki.issn.1674-4152.002717

血清脂蛋白相关磷脂酶A2水平与颈动脉粥样硬化斑块的相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.002717

田雪¹,
黄柳²,
姚菁青¹,
李云涛^2, ,

1.
南京医科大学第二附属医院神经内科，江苏南京 210011
2.
南京医科大学第二附属医院全科医学科，江苏南京 210011

基金项目:

中国学位与研究生教育学会课题 B2-20170304-02

江苏省卫健委十三五“科教强卫工程”青年医学重点人才资助项目 QNRC2016677

南京医科大学研究生教育教学改革课题 SPOCYB201913

详细信息

通讯作者:
李云涛, E-mail: liyuntao@njmu.edu.cn

中图分类号: R543.4
计量
- 文章访问数: 287
- HTML全文浏览量: 101
- PDF下载量: 9
- 被引次数: 0
出版历程
- 收稿日期: 2022-01-17
- 网络出版日期: 2022-12-30

Correlation analysis between serum Lp-PLA2 level and carotid atherosclerotic plaque

1.
Department of Neurology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, China

摘要

摘要: 目的探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)水平与颈动脉粥样硬化斑块的相关性。方法选择2019年6月—2020年12月于南京医科大学第二附属医院行颈动脉超声及Lp-PLA2检测的住院患者1 018例，根据检查结果将患者分为：(1)无斑块(31例)、稳定(376例)和不稳定斑块组(611例)；(2)无斑块(31例)、单侧(324例)和双侧颈动脉斑块组(663例)；(3)无狭窄(31例)、轻度(932例)、中度(26例)和重度颈动脉狭窄组(29例)。计算所有患者的斑块总面积、稳定斑块面积和不稳定斑块面积。分析Lp-PLA2水平在各组间的差异性及与斑块面积的相关性。结果与无斑块组[139.00(96.00，193.00)ng/mL]比较，不稳定斑块组[179.00(123.00，281.00)ng/mL]和双侧斑块组[181.00(120.00，279.00)ng/mL]Lp-PLA2水平明显升高(均P < 0.05)。颈动脉无狭窄及轻度狭窄患者的Lp-PLA2水平与中、重度狭窄患者之间差异有统计学意义(均P < 0.01)。Lp-PLA2与斑块总面积、不稳定斑块面积之间均呈正相关关系(均P < 0.05)。Lp-PLA2对中重度颈动脉狭窄存在较高的诊断价值(AUC=0.710，灵敏度为43.6%，特异度为89.7%，P < 0.001，95% CI: 0.631~0.789)。结论 Lp-PLA2与颈动脉斑块稳定度、血管狭窄程度、双侧斑块形成及斑块面积，尤其是不稳定斑块面积显著相关，对颈动脉粥样硬化斑块的形成和发展有促进作用。Lp-PLA2对中重度颈动脉狭窄具有较高的诊断价值，可能是大规模临床筛查较好的提示指标。
- 脂蛋白相关磷脂酶A2 /
- 颈动脉粥样硬化斑块 /
- 颈动脉超声
Abstract: Objective To explore the correlation between lipoprotein associated phospholipase A2 (Lp-PLA2) and carotid atherosclerotic plaque. Methods A total of 1 018 patients who underwent carotid artery ultrasound and Lp-PLA2 detection from June 2019 to December 2020 in the Second Affiliated Hospital of Nanjing Medical University were selected. Based on the test results, patients were divided into (1) non-carotid plaque group (31 cases), stable group (376 cases) and unstable group (611 cases); (2) non-carotid plaque group (31 cases), unilateral group (324 cases) and bilateral group (663 cases); (3) no stenosis group (31 cases), mild (932 cases), moderate (26 cases) and severe carotid stenosis (29 cases). The total plaque area, stable plaque area, and unstable plaque area of all patients were calculated. The difference of Lp-PLA2 level among groups and the correlation of plaque area were analyzed. Results Compared with the non-plaque group [139.00 (96.00, 193.00) ng/mL], the Lp-PLA2 level in the unstable plaque group [179.00 (123.00, 281.00) ng/mL] and the bilateral plaque group [181.00 (120.00, 279.00) ng/mL] were significantly increased (all P < 0.05). The level of Lp-PLA2 in patients without carotid stenosis and with mild carotid stenosis were significantly different from that in patients with moderate and severe carotid stenosis (all P < 0.01). Lp-PLA2 was positively correlated with total plaque area and unstable plaque area (all P < 0.05). Lp-PLA2 had high diagnostic value for moderate and severe carotid artery stenosis (AUC=0.710, sensitivity was 43.6%, specificity was 89.7%, P < 0.001, 95% CI: 0.631-0.789). Conclusion Lp-PLA2 is significantly correlated with carotid plaque stability, vascular stenosis, bilateral plaque formation and plaque area, especially unstable plaque area, which can promote the formation and development of carotid atherosclerotic plaque. Lp-PLA2 has high diagnostic value for moderate and severe carotid stenosis, and may be a good indicator for large-scale clinical screening.
- Lipoprotein-associated phospholipase A2 /
- Carotid atherosclerosis plaque /
- Carotid ultrasound

HTML全文

图 1 Lp-PLA2诊断不稳定斑块和中重度颈动脉狭窄的ROC曲线

注：A为不稳定斑块；B为中重度颈动脉狭窄。

Figure 1. The ROC curve of Lp-PLA2 for diagnosis of unstable plaque and moderate to severe carotid stenosis

下载: 全尺寸图片幻灯片

表 1 Lp-PLA2与颈动脉斑块稳定度的关系[M(P₂₅, P₇₅), ng/mL]

Table 1. Relationship between Lp-PLA2 and carotid plaque stability[M(P₂₅, P₇₅), ng/mL]

组别	例数	Lp-PLA2
无斑块	31	139.00(96.00，193.00)
稳定斑块	376	161.50(114.00，271.00)
不稳定斑块	611	179.00(123.00，281.00)^a
H值		11.862
P值		0.003
注：与无斑块组比较，^aP < 0.01。

下载: 导出CSV

表 2 Lp-PLA2与颈动脉斑块单双侧的关系[M(P₂₅, P₇₅), ng/mL]

Table 2. Relationship of Lp-PLA2 between non-carotid plaque, unilateral and bilateral group[M(P₂₅, P₇₅), ng/mL]

组别	例数	Lp-PLA2
无斑块	31	139.00(96.00，193.00)
单侧	324	157.00(113.25，265.50)
双侧	663	181.00(120.00，279.00)^a
H值		9.937
P值		0.007
注：与无斑块组比较，^aP < 0.01。

下载: 导出CSV

表 3 Lp-PLA2与颈动脉狭窄程度的关系[M(P₂₅, P₇₅), ng/mL]

Table 3. Relationship between Lp-PLA2 and degree of carotid stenosis[M(P₂₅, P₇₅), ng/mL]

组别	例数	Lp-PLA2
无狭窄	31	139.00(96.00，93.00)
轻度狭窄	932	167.50(117.00，270.00)
中度狭窄	26	257.50(138.50，394.00)^ab
重度狭窄	29	333.00(161.00，430.50)^ab
H值		34.004
P值		< 0.001
注：与无狭窄组比较，^aP < 0.01；与轻度狭窄组比较，^bP < 0.01。

下载: 导出CSV

表 4 Lp-PLA2与斑块总面积、稳定斑块面积、不稳定斑块面积的相关性分析

Table 4. Correlation analysis of Lp-PLA2 with carotid plaque area

组别	Lp-PLA2
组别	r值	P值
斑块总面积	0.094	0.003
稳定斑块面积	-0.003	0.918
不稳定斑块面积	0.109	< 0.001

下载: 导出CSV

表 5 Lp-PLA2对不稳定斑块和中重度颈动脉狭窄的诊断价值

Table 5. Diagnostic value of Lp-PLA2 in unstable plaque and moderate to severe carotid stenosis

组别	AUC	临界值(ng/mL)	P值	95% CI	灵敏度(%)	特异度(%)
不稳定斑块	0.552	150.00	0.005	0.516~0.588	61.5	47.7
中重度颈动脉狭窄	0.710	332.00	< 0.001	0.631~0.789	43.6	89.7

下载: 导出CSV

参考文献(20)

[1]	王亚楠, 吴思缈, 刘鸣. 中国脑卒中15年变化趋势和特点[J]. 华西医学, 2021, 36(6): 803-807. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX202106017.htm WANG Y N, WU S M, LIU M. Temporal trends and characteristics of stroke in China in the past 15 years[J]. West China Medical Journal, 2021, 36(6): 803-807. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX202106017.htm
[2]	WU S M, WU B, LIU M, et al. Stroke in China: Advances and challenges in epidemiology, prevention, and management[J]. Lancet Neurol, 2019, 18(4): 394-405. doi: 10.1016/S1474-4422(18)30500-3
[3]	MESCHIA J F, BUSHNELL C, BODEN-ALBALA B, et al. Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2014, 45(12): 3754-3832. doi: 10.1161/STR.0000000000000046
[4]	STAFFORINI D M. Plasma PAF-AH (PLA2G7): Biochemical properties, association with LDLs and HDLs, and regulation of expression[J]. Enzymes, 2015, 38: 71-93.
[5]	CAO J, YAN P, ZHOU Y J, et al. Clinical utility of the serum level of lipoprotein-related phospholipase A2 in acute ischemic stroke with cerebral artery stenosis[J]. Front Neurol, 2021, 12: 642483. DOI: 10.3389/fneur.2021.642483.
[6]	李振洲, 邵玉凤, 陈胜华, 等. 颈动脉斑块稳定性超声评估与血浆脂蛋白相关磷脂酶A2水平的相关性研究[J]. 中国临床医学影像杂志, 2019, 30(3): 166-168, 173. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX201903007.htm LI Z Z, SHAO Y F, CHEN S H, et al. Correlation between stability of carotid plaque evaluated by ultrasound and the level of plasma Lp-PLA2[J]. Journal of China Clinic Medical Imaging, 2019, 30(3): 166-168, 173. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX201903007.htm
[7]	张瑾, 潘凤华, 吴晋. 脑梗死患者脂蛋白相关磷脂酶A2水平及其与颈动脉斑块稳定性的相关性研究[J]. 系统医学, 2018, 3(14): 1-3. https://www.cnki.com.cn/Article/CJFDTOTAL-XTYX201814001.htm ZHANG J, PAN F H, WU J. Study on Correlation between the Lipoprotein Associated Phospholipase A2 and Stability of Carotid Artery Plaque of Patients with Cerebral Infraction[J]. Systems Medicine, 2018, 3(14): 1-3. https://www.cnki.com.cn/Article/CJFDTOTAL-XTYX201814001.htm
[8]	郝泽林, 吴建跃, 滕振飞, 等. 急性脑梗死患者血清学指标与神经功能缺损和脑梗死体积及颈动脉斑块性质的相关性研究[J]. 中华全科医学, 2020, 18(11): 1803-1806. doi: 10.16766/j.cnki.issn.1674-4152.001623 HAO Z L, WU J Y, TENG Z F, et al. Correlation of hs-CRP, MMP-9 and Lp-PLA2 with neurological deficit, cerebral infarction volume and carotid plaque properties in patients with acute cerebral infarction[J]. Chinese Journal of General Practice, 2020, 18(11): 1803-1806. doi: 10.16766/j.cnki.issn.1674-4152.001623
[9]	中国医师协会神经内科医师分会神经超声专业委员会, 中华医学会神经病学分会神经影像协作组. 中国神经超声的操作规范(三)[J]. 中华医学杂志, 2017, 97(43): 3361-3370. doi: 10.3760/cma.j.issn.0376-2491.2017.43.001 Neuroultrasound Professional Committee of Chinese Medical Doctor Association, Neuroimaging Collaborative Group of Chinese Society of Neurology. Chinese Code of practice for neuroultrasound(3)[J]. National Medical Journal of China, 2017, 97(43): 3361-3370. doi: 10.3760/cma.j.issn.0376-2491.2017.43.001
[10]	LIU H M, YAN Y, WANG Y X, et al. Association between high-sensitivity C-reactive protein, lipoprotein-associated phospholipase A2 and carotid atherosclerosis: A cross-sectional study[J]. J Cell Mol Med, 2018, 22(10): 5145-5150.
[11]	HUANG X Y, WANG A X, LIU X X, et al. Association between high sensitivity C-reactive protein and prevalence of asymptomatic carotid artery stenosis[J]. Atherosclerosis, 2016, 246: 44-49.
[12]	SASAI M, ISO Y, MIZUKAMI T, et al. Potential contribution of the hepcidin-macrophage axis to plaque vulnerability in acute myocardial infarction in human[J]. Int J Cardiol, 2017, 227: 114-121.
[13]	DENNIS E A, JIAN C, HSU Y H, et al. Phospholipase A2 enzymes: Physical structure, biological function, disease implication, chemical inhibition, and therapeutic intervention[J]. Chem Rev, 2011, 111(10): 6130-6185.
[14]	HUANG F B, WANG K, SHEN J H. Lipoprotein-associated phospholipase A2: The story continues[J]. Med Res Rev, 2020, 40(1): 79-134.
[15]	LIANG T, WANG S C, ZHANG D T, et al. Evaluation of lipoprotein-associated phospholipase A2, serum amyloid A, and fibrinogen as diagnostic biomarkers for patients with acute cerebral infarction[J]. J Clin Lab Anal, 2020, 34(3): e23084. DOI: 10.1002/jcla.23084.
[16]	陆强彬, 陆梦茹, 朱祖福, 等. 脂蛋白相关磷脂酶A2、脂蛋白(a)与脑梗死进展及头颈部血管狭窄的相关性[J]. 中国动脉硬化杂志, 2018, 26(12): 1270-1272, 1290. https://www.cnki.com.cn/Article/CJFDTOTAL-KDYZ201812016.htm LU Q B, LU M R, ZHU Z F, et al. The correlation of lipoprotein associated phospholipase A2 and lipoprotein(a) with progress of cerebral infarction and the vascular stenosis of intracranial and external[J]. Chinese Journal of Arteriosclerosis, 2018, 26(12): 1270-1272, 1290. https://www.cnki.com.cn/Article/CJFDTOTAL-KDYZ201812016.htm
[17]	ALSULAIMANI S, GARDENER H, ELKIND M, et al. Elevated homocysteine and carotid plaque area and densitometry in the Northern Manhattan Study[J]. Stroke, 2013, 44(2): 457-461.
[18]	WEI L L, KE Z Y, ZHAO Y, et al. The elevated lipoprotein-associated phospholipase A2 activity is associated with the occurrence and recurrence of acute cerebral infarction[J]. Neuroreport, 2017, 28(6): 325-330.
[19]	王亚飞, 李惠勉. 动脉粥样硬化血栓形成性脑梗死患者血清Lp-PLA2水平变化及其意义[J]. 山东医药, 2018, 58(11): 72-74. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY201811022.htm WANG Y F, LI H M. Changes and significance of serum LP-PLA2 levels in patients with atherosclerotic thrombotic cerebral infarction[J]. Shandong Medical Journal, 2018, 58(11): 72-74. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY201811022.htm
[20]	STEFANO A D, MA NN UCCI L, TAMBURI F, et al. Lp-PLA2, a new biomarker of vascular disorders in metabolic diseases[J]. Int J Immunopathol Pharmacol, 2019, 33: 205873841982715. DOI: 10.1177/2058738419827154.