血浆脂蛋白相关磷脂酶A2和同型半胱氨酸水平与急性脑梗死的关系研究
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摘要
目的探究血浆脂蛋白相关磷脂酶A2(lipoprotein associated phospholipase A2,Lp-PLA2)、同型半胱氨酸(homocysteine,Hcy)水平与急性脑梗死(acute cerebral infarction,ACI)的关系。方法选取2016年5月-2018年8月我院ACI患者104例作为实验组,另选取同期68例健康体检者作为对照组。测定对比两组对象血浆Lp-PLA2、Hcy水平,实验组不同脑梗死面积、病情严重程度患者血浆Lp-PLA2、Hcy水平,分析血浆Lp-PLA2、Hcy水平和ACI患者神经功能缺损程度评分(National Institutes of Health Stroke Scale,NHISS)、脑梗死面积之间相关性,对比单独及联合应用血浆Lp-PLA2、Hcy水平检测诊断ACI的特异度、敏感度及准确度。结果实验组血浆Lp-PLA2、Hcy水平均高于对照组(P均<0.05);实验组不同脑梗死面积患者血浆Lp-PLA2、Hcy水平差异均有统计学意义(P均<0.05),且大面积梗死者血浆Lp-PLA2、Hcy水平高于中等和小面积梗死者,中等面积梗死者高于小面积梗死者(P均<0.05);实验组不同病情严重程度患者血浆Lp-PLA2、Hcy水平差异均有统计学意义(P均<0.05),且病情严重程度为重度者高于中度和轻度者,中度者高于轻度者(P均<0.05);相关性分析结果显示,血浆Lp-PLA2、Hcy水平和ACI患者的NHISS评分、脑梗死面积间呈正相关(P均<0.05);应用血浆Lp-PLA2、Hcy水平联合诊断ACI的敏感度88.46%、准确度85.47%均高于应用单一方法诊断(P均<0.05)。结论急性脑梗死患者血浆Lp-PLA2、Hcy水平增高,其水平与患者脑梗死面积、病情严重程度呈正相关,应用两指标联合检测可提升ACI诊断的敏感度与准确度,减少漏诊。
Objective To investigate the relationship between plasma lipoprotein-associated phospholipase A2(Lp-PLA2),homocysteine(Hcy)levels and acute cerebral infarction(ACI). Methods From May2016 to August 2018,104 patients with ACI in our hospital were selected as the experimental group,and68 healthy subjects in the same period were selected as the control group. Plasma Lp-PLA2 and Hcy levels were measured and compared between the two groups. Plasma Lp-PLA2 and Hcy levels were measured in patients with different cerebral infarction size and severity,and plasma Lp-PLA2,Hcy levels and ACI patients' neurological deficit scores were analyzed(National Institutes). The correlation between the health and cerebral infarction area,the specificity,sensitivity and accuracy of the diagnosis of ACI compared with the combined use of plasma Lp-PLA2 and Hcy levels. Results The plasma levels of Lp-PLA2 and Hcy in the experimental group were higher than those in the control group(P all <0.05);the plasma levels of Lp-PLA2 and Hcy in the patients with different cerebral infarction areas in the experimental group were significantly different(P all <0.05),and the plasma levels of Lp-PLA2 and Hcy in the patients with large area infarction were higher than those with medium and small area infarction,and those with medium area infarction were higher than those with small area infarction(P all <0.05). There were significant differences in plasma Lp-PLA2 and Hcy levels in patients with severity(P all <0.05),and the severity of the disease was higher in severe patients than that in moderate and mild patients(P all <0.05). The correlation analysis showed that plasma Lp-PLA2,Hcy levels were positively correlated with NHISS scores and cerebral infarction area in ACI patients(P all <0.05);plasma Lp-PLA2 and Hcy levels were positively correlated with cerebral infarction area in ACI patients(P all <0.05). The sensitivity and accuracy of plain combined diagnosis of ACI were 88.46% and 85.47% higher than that of single diagnosis(P all <0.05).Conclusion The level of plasma Lp-PLA2 and Hcy increased in patients with acute cerebral infarction,which was positively correlated with the area of cerebral infarction and the severity of the disease. The combined detection of the two indicators could improve the sensitivity and accuracy of ACI diagnosis and reduce missed diagnosis.
Objective To investigate the relationship between plasma lipoprotein-associated phospholipase A2(Lp-PLA2),homocysteine(Hcy)levels and acute cerebral infarction(ACI). Methods From May2016 to August 2018,104 patients with ACI in our hospital were selected as the experimental group,and68 healthy subjects in the same period were selected as the control group. Plasma Lp-PLA2 and Hcy levels were measured and compared between the two groups. Plasma Lp-PLA2 and Hcy levels were measured in patients with different cerebral infarction size and severity,and plasma Lp-PLA2,Hcy levels and ACI patients' neurological deficit scores were analyzed(National Institutes). The correlation between the health and cerebral infarction area,the specificity,sensitivity and accuracy of the diagnosis of ACI compared with the combined use of plasma Lp-PLA2 and Hcy levels. Results The plasma levels of Lp-PLA2 and Hcy in the experimental group were higher than those in the control group(P all <0.05);the plasma levels of Lp-PLA2 and Hcy in the patients with different cerebral infarction areas in the experimental group were significantly different(P all <0.05),and the plasma levels of Lp-PLA2 and Hcy in the patients with large area infarction were higher than those with medium and small area infarction,and those with medium area infarction were higher than those with small area infarction(P all <0.05). There were significant differences in plasma Lp-PLA2 and Hcy levels in patients with severity(P all <0.05),and the severity of the disease was higher in severe patients than that in moderate and mild patients(P all <0.05). The correlation analysis showed that plasma Lp-PLA2,Hcy levels were positively correlated with NHISS scores and cerebral infarction area in ACI patients(P all <0.05);plasma Lp-PLA2 and Hcy levels were positively correlated with cerebral infarction area in ACI patients(P all <0.05). The sensitivity and accuracy of plain combined diagnosis of ACI were 88.46% and 85.47% higher than that of single diagnosis(P all <0.05).Conclusion The level of plasma Lp-PLA2 and Hcy increased in patients with acute cerebral infarction,which was positively correlated with the area of cerebral infarction and the severity of the disease. The combined detection of the two indicators could improve the sensitivity and accuracy of ACI diagnosis and reduce missed diagnosis.
引文
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[12] Camerlingo M,Tudose V,Tognozzi M,et al. Predictors of re-canalisation in acute cerebral infarction from occlusion of the terminal internal carotid artery or of the middle cerebral artery mainstem treated with thrombolysis[J]. Int J Neurosci,2014,124(3):199-203.
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[14]张作念,王志晔,顾伟,等.急性脑梗死患者血清炎症因子与颈动脉粥样硬化斑块性质关系的临床研究[J].重庆医学,2016,45(10):1375-1377.
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[16] Isabel C,Lecler A,Turc G,et al. Relationship between watershed infarcts and recent intra plaque haemorrhage in carotid atherosclerotic plaque[J].Plos One,2014,9(10):e108712.
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[18]禹萌,任雅芳,王煜姝,等.急性脑梗死患者血清中CyPA、Lp-PLA2含量与动脉粥样硬化、神经损伤的相关性[J].中国现代医学杂志,2018,28(16):44-47.
[19]赵鑫,章晓富,位慧芳.血清Lp-PLA2、MMP-9、NSE水平与急性脑梗死患者神经损伤程度的关系研究[J].实用预防医学,2018,25(4):480-482.
[20]蒋晓静.急性脑梗死患者血清Hcy、IL及NO检测及其临床意义[J].陕西医学杂志,2016,45(7):855-856.
[21]刘少平,韩利蓉,余卉,等.急性脑梗死血清Hcy、hs-CRP及NSE的水平变化[J].心脑血管病防治,2016,16(2):127-128.
[22]康建华,杨立顺,袁海生,等.血浆Lp-PLA2、HCY、血脂水平预测急性脑梗死的价值[J].山东医药,2014,54(45):62-64.
[23]孟云,朱言亮.急性脑梗死诊断中NSE、HCY和H-FABP的表达及意义[J].中国实验诊断学,2015,19(1):30-32.
[2]陈宏宝,张宝玉.丹参川芎嗪注射液治疗急性脑梗死56例的临床观察[J].实用临床医药杂志,2013,17(7):96-97.
[3] He X,Li DR,Cui C,et al. Clinical significance of serum MCP-1 and VE-cadherin levels in patients with acute cerebral infarction[J]. Eur Rev Med Pharmacol Sci,2017,21(4):804-808.
[4]金彪,王永杰,邹明,等. 1.5T MRI评价颈动脉粥样硬化与脑梗死的相关性研究[J].中国医学计算机成像杂志,2016,22(4):297-300.
[5]田怡,欧阳松,王家祺,等. Hcy,hs-CRP与急性脑梗死患者颈动脉粥样硬化关系的研究[J].现代生物医学进展,2016,16(20):3853-3855.
[6] Drechsler H,Masztalewicz M,Safranow K,et al. CD4CD28 lymphocytes and cerebral ischaemic stroke.Part II:CD4 CD28 lymphocytes and carotid artery atherosclerotic plaque characteristics[J]. Neurol Neurochir Pol,2013,47(3):208-213.
[7]戚志强,董海蓉,周红,等.急性脑梗死患者病情与血清Lp-PLA2水平的相关性[J].江苏医药,2017,43(14):1013-1015.
[8]刘晓东,秦海东,沈华,等.不同程度急性脑梗死患者血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平及临床意义[J].陕西医学杂志,2016,45(9):1138-1139.
[9]张秀丽.血清D-二聚体、同型半胱氨酸联合检测在急性脑梗死中的应用效果[J].中国临床医生杂志,2017,45(7):54-57.
[10]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[11] Wen X,Wang Y,Zhang F,et al. In vivo monitoring of neural stem cells after transplantation in acute cerebral infarction with dual-modal MR imaging and optical imaging[J]. Biomaterials,2014,35(16):4627-4635.
[12] Camerlingo M,Tudose V,Tognozzi M,et al. Predictors of re-canalisation in acute cerebral infarction from occlusion of the terminal internal carotid artery or of the middle cerebral artery mainstem treated with thrombolysis[J]. Int J Neurosci,2014,124(3):199-203.
[13]闫静,许铁.急性缺血性脑卒中患者脂蛋白相关磷脂酶A2和同型半胱氨酸水平的变化及影响因素[J].中国急救医学,2014,34(11):992-995.
[14]张作念,王志晔,顾伟,等.急性脑梗死患者血清炎症因子与颈动脉粥样硬化斑块性质关系的临床研究[J].重庆医学,2016,45(10):1375-1377.
[15]王位,黎红华.动脉粥样硬化与脑梗死危险因素[J].现代中西医结合杂志,2014,23(1):109-111.
[16] Isabel C,Lecler A,Turc G,et al. Relationship between watershed infarcts and recent intra plaque haemorrhage in carotid atherosclerotic plaque[J].Plos One,2014,9(10):e108712.
[17]赵培,李永辉,霍丽静,等.急性缺血性脑卒中患者血清脂蛋白相关磷脂酶A2的临床研究[J].医学动物防制,2016,32(10):1098-1100.
[18]禹萌,任雅芳,王煜姝,等.急性脑梗死患者血清中CyPA、Lp-PLA2含量与动脉粥样硬化、神经损伤的相关性[J].中国现代医学杂志,2018,28(16):44-47.
[19]赵鑫,章晓富,位慧芳.血清Lp-PLA2、MMP-9、NSE水平与急性脑梗死患者神经损伤程度的关系研究[J].实用预防医学,2018,25(4):480-482.
[20]蒋晓静.急性脑梗死患者血清Hcy、IL及NO检测及其临床意义[J].陕西医学杂志,2016,45(7):855-856.
[21]刘少平,韩利蓉,余卉,等.急性脑梗死血清Hcy、hs-CRP及NSE的水平变化[J].心脑血管病防治,2016,16(2):127-128.
[22]康建华,杨立顺,袁海生,等.血浆Lp-PLA2、HCY、血脂水平预测急性脑梗死的价值[J].山东医药,2014,54(45):62-64.
[23]孟云,朱言亮.急性脑梗死诊断中NSE、HCY和H-FABP的表达及意义[J].中国实验诊断学,2015,19(1):30-32.