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
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- 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

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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。

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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。

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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。

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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

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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

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