血浆脂蛋白相关磷脂酶A2联合血清抵抗素对动脉粥样硬化性脑梗死患者预后转归的评估价值
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摘要
目的目前关于血浆脂蛋白相关磷脂酶A2(LP-PLA2)水平和血清抵抗素在预测动脉粥样硬化性脑梗死患者预后转归的研究较少。文中旨在探讨LP-PLA2、血清抵抗素对于动脉粥样硬化性脑梗死患者预后风险率的预测价值。方法选取2013年9月至2014年9月河南大学淮河医院神经内科诊断为动脉粥样硬化性脑梗死患者136例。随访时间2015年1月至2017年1月,根据随访结果分为预后不良组、预后良好组。Cox比例风险模型评价患者预后的影响因素;运用ROC曲线分析上述因素预测动脉粥样硬化性脑梗死患者预后风险的敏感性和特异性。结果随访期间失访12人,预后不良组48例,预后良好组76例。Cox比例风险模型结果显示患者LP-PLA2水平(OR=2.105,95%CI:1.878~2.413)、血清抵抗素(OR=1.784,95%CI:1.509~2.213)对预后有显著影响。预后不良组LP-PLA2、血清抵抗素水平显著高于预后良好组[(268.65±89.02)vs(128.78±76.22)mg/L,(24.36±4.87)vs(20.71±6.15)mg/L],差异有统计学意义(P=0.000、0.001)。ROC曲线下LPPLA2联合血清抵抗素敏感度为81.35%,特意度为78.26%。结论 LP-PLA2联合血清抵抗素对动脉粥样硬化性脑梗死患者预后有较好的预测能力。
Objective Few studies are reported about the values of the levels of plasma lipoprotein related phospholipase A2( LP-PLA2) and serum resistin in predicting the prognosis of atherosclerotic cerebral infarction( ACI). This article aims to evaluate the predictive values of LP-PLA2 and serum resistin in the prognosis of ACI. Methods This study included 136 cases of ACI diagnosed and treated in Huaihe Hosptial from September 2013 to September 2014. The patients were followed up for 2 years,during which 48 were found with adverse outcomes( the poor prognosis group) 76 without disease progression( the good prognosis group). We analyzed the influencing factors on prognosis using the Cox proportional hazard model and evaluated the sensitivity and specificity of these factors in predicting the prognostic risks of the patients by ROC curve analysis. Results The rate of poor prognosis was 38.71% among the included patients. Analysis with the Cox proportional hazard model showed significant impacts of LP-PLA2( OR = 2. 105,95% CI:1.878-2.413) and serum resistin( OR = 1. 784,95% CI: 1. 509-2.213) on the prognosis of the patients. Compared with the good prognosis group,the poor prognosis group exhibited markedly higher levels of LP-PLA2( [128.78±76.22] vs [268.65±89.02] mg/L,P<0.01)and serum resistin( [20.71±6.15] vs [24.36±4.87] mg/L,P<0.01). The sensitivity and specificity of LP-PLA2 combined with serum resistin were 81.35% and 78.26%,respectively. Conclusion The combination of LP-PLA2 with serum resistin has a good predictive value for the prognosis of atherosclerotic cerebral infarction and is expected to be widely applied as a routine index in clinical practice.
Objective Few studies are reported about the values of the levels of plasma lipoprotein related phospholipase A2( LP-PLA2) and serum resistin in predicting the prognosis of atherosclerotic cerebral infarction( ACI). This article aims to evaluate the predictive values of LP-PLA2 and serum resistin in the prognosis of ACI. Methods This study included 136 cases of ACI diagnosed and treated in Huaihe Hosptial from September 2013 to September 2014. The patients were followed up for 2 years,during which 48 were found with adverse outcomes( the poor prognosis group) 76 without disease progression( the good prognosis group). We analyzed the influencing factors on prognosis using the Cox proportional hazard model and evaluated the sensitivity and specificity of these factors in predicting the prognostic risks of the patients by ROC curve analysis. Results The rate of poor prognosis was 38.71% among the included patients. Analysis with the Cox proportional hazard model showed significant impacts of LP-PLA2( OR = 2. 105,95% CI:1.878-2.413) and serum resistin( OR = 1. 784,95% CI: 1. 509-2.213) on the prognosis of the patients. Compared with the good prognosis group,the poor prognosis group exhibited markedly higher levels of LP-PLA2( [128.78±76.22] vs [268.65±89.02] mg/L,P<0.01)and serum resistin( [20.71±6.15] vs [24.36±4.87] mg/L,P<0.01). The sensitivity and specificity of LP-PLA2 combined with serum resistin were 81.35% and 78.26%,respectively. Conclusion The combination of LP-PLA2 with serum resistin has a good predictive value for the prognosis of atherosclerotic cerebral infarction and is expected to be widely applied as a routine index in clinical practice.
引文
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[15]童艳飞,张佩兰.NIHSS评分≥15分且发病时间≤4.5h的重型脑梗死患者静脉溶栓的疗效观察[J].实用医学杂志,2016,32(5):812-815.
[16]李娜,高俊淑,杨蕊,等.舒血宁注射液对脑梗死伴肺感染患者血流变学与Lp-PLA2水平的影响[J].中华医院感染学杂志,2016,26(20):4651-4653.
[17]刘香,戴世荣,顾玲莉.脑梗死患者脂蛋白相关磷脂酶A2水平及临床意义[J].检验医学与临床,2015(23):3586-3588.
[18]王少颖,王青青,李净兵,等.血清抵抗素、脂联素、C反应蛋白水平变化与急性脑梗死患者颈动脉粥样硬化的相关性分析[J].临床和实验医学杂志,2015(21):1774-1777.
[19]Shi J,Kai H,Qi P,et al.Confirmation of the abnormal lipid metabolism as a risk factor for the disease of leukoaraiosis[J].Saudi J Biol Sci,2017,24(3):508.
[2]Hariri E,Hachem A,Sarkis G,et al.Optimal Duration of Monitoring for Atrial Fibrillation in Cryptogenic Stroke:A Nonsystematic Review[J].Bio Med Res Int,2016,(2016-5-29),2016,2016(19):1-10.
[3]李铁威,丛祥凤,陈曦.心血管疾病生物标志物--脂蛋白相关磷脂酶A2的临床应用价值[J].中国循环杂志,2016,31(4):410-413.
[4]黄晓芸,徐安定,梅志忠,等.炎症因子与急性动脉粥样硬化性脑梗死及其预后的关系[J].广东医学,2015(19):2994-2997.
[5]Dong XL,Xu SJ,Zhang L,et al.Serum Resistin Levels May Contribute to an Increased Risk of Acute Cerebral Infarction[J].Mol Neurobiol,2017,54(3):1-8.
[6]Naess H,Kurtz M,Thomassen L,et al.Serial NIHSS scores in patients with acute cerebral infarction[J].Acta Neurol Scand,2016,133(6):415.
[7]Saitoh E,Sugita K,Kurosawa H,et al.Cerebral infarction in acute promyelocytic leukemia at initial presentation[J].Acta Paediatr Jpn,2015,37(6):710-712.
[8]刘柯婷,周淑宇,蔡必扬,等.高敏C反应蛋白和大动脉粥样硬化型卒中严重程度的相关性研究[J].医学研究生学报,2015,28(10):1043-1047.
[9]戴敏慧,资文杰,蔡必扬,等.血清清蛋白与缺血性脑卒中短期功能预后的关系[J].医学研究生学报,2015,28(11):1152-1155.
[10]陈宗存,符沙沙,陈金逸,等.脑梗死合并亚临床甲状腺功能减退与内脂素及内皮素的关系[J].医学研究生学报,2017,30(10):1053-1056.
[11]陈后勤,吕秋石,何敏,等.急性腔隙性脑梗死患者慢性肾功能不全与脑微出血的相关性研究[J].医学研究生学报,2017,30(3):294-297.
[12]许永乐,贾鑫,郭伟,等.紫杉醇药物涂层球囊治疗症状性下肢动脉硬化闭塞症的早中期结果[J].中华外科杂志,2016,54(8):617-619.
[13]Tian C,Li Z,Yang Z,et al.Plasma MicroRNA-16 Is a Biomarker for Diagnosis,Stratification,and Prognosis of Hyperacute Cerebral Infarction[J].PLo S One,2016,11(11):e0166688.
[14]Li C,Zhao GF,He QY,et al.Study on the clinical efficacy of Human Urinary Kalllikrein in the treatment of acute cerebral infarction according to TOAST classification[J].Pak J Pharm Sci,2015,28(4 Suppl):1505-1510.
[15]童艳飞,张佩兰.NIHSS评分≥15分且发病时间≤4.5h的重型脑梗死患者静脉溶栓的疗效观察[J].实用医学杂志,2016,32(5):812-815.
[16]李娜,高俊淑,杨蕊,等.舒血宁注射液对脑梗死伴肺感染患者血流变学与Lp-PLA2水平的影响[J].中华医院感染学杂志,2016,26(20):4651-4653.
[17]刘香,戴世荣,顾玲莉.脑梗死患者脂蛋白相关磷脂酶A2水平及临床意义[J].检验医学与临床,2015(23):3586-3588.
[18]王少颖,王青青,李净兵,等.血清抵抗素、脂联素、C反应蛋白水平变化与急性脑梗死患者颈动脉粥样硬化的相关性分析[J].临床和实验医学杂志,2015(21):1774-1777.
[19]Shi J,Kai H,Qi P,et al.Confirmation of the abnormal lipid metabolism as a risk factor for the disease of leukoaraiosis[J].Saudi J Biol Sci,2017,24(3):508.