脑卒中患者血浆Lp-PLA2水平及临床意义探讨

摘要

Objective To investigate the changes of lipoprotein-associated phospholipase A2 (Lp-PLA2)level in patients with stroke,and to research the correlation with the volume of cerebral infarction and the severity of neurological impairment in patients with ischemic stroke.Methods A total of 180 ischemic stroke patients,165 hemorrhagic stroke patients and 105 healthy subjects (healthy control group ) were enrolled.By enzyme-linked immunosorbent assay (ELISA),the plasma Lp-PLA2 levels were determined,and the receiver operating characteristic (ROC)curve was used to evaluate the efficacy of Lp-PLA2 in the diagnosis of ischemic stroke and hemorrhagic stroke.The blood lipids [total cholesterol (TC),triglyceride (TG),high-density lipoprotein cholesterol (HDL-C)and low-density lipoprotein cholesterol (LDL-C)],glucose (Glu)and fibrinogen (FIB)were determined.The volumes of cerebral infarction were measured by cranium magnetic resonance imaging,and the severities of neurological impairment were assessed by the National Institutes of Health Stroke Scale.The correlation of plasma Lp-PLA2 with the National Institutes of Health Stroke Scale was analyzed.Results The levels of Lp-PLA2,TC,HDL-C,LDL-C and FIB among ischemic stroke, hemorrhagic stroke and healthy control groups had statistical significance (P<0.05 ).TG and Glu had no statistical significance between ischemic stroke and hemorrhagic stroke groups (P=0.133 and 0.067),and there were statistical significance with those in healthy control group(P<0.05).The area under the ROC curve (AUC)was 0.905,and the optimal cut-off value was 42.35 μg/L.The diagnostic sensitivity and specificity of plasma Lp-PLA2 were 81.5% and 80.0%.Plasma Lp-PLA2 increased with the increase of the volume of cerebral infarction,but it had no statistical significance(H =0.372,P =0.719 ).Spearman correlation analysis showed that plasma Lp-PLA2 had significant correlation with the National Institutes of Health Stroke Scale (P<0.05 ).Conclusions Plasma Lp-PLA2 increases significantly in patients with ischemic stroke,and it is significantly correlated with the National Institutes of Health Stroke Scale.Plasma Lp-PLA2 is an independent risk factor for ischemic stroke,and it may be a prediction index of ischemic stroke and a useful parameter for the severity of patient′s condition.%目的：研究脑卒中患者血浆脂蛋白相关磷脂酶A2（Lp-PLA2）的变化，探讨其与缺血性脑卒中梗死灶大小和神经功能缺损程度的关系。方法采用酶联免疫吸附试验（ELISA）测定180例缺血性脑卒中患者、165例出血性脑卒中患者及105名健康对照者（正常对照组）血浆Lp-PLA2水平，同时测定血脂[总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）]、葡萄糖（Glu）及纤维蛋白原（FIB）。采用受试者工作特征（ROC）曲线评价Lp-PLA2对缺血性脑卒中和出血性脑卒中的诊断效能；采用头颅核磁共振检查脑梗死体积大小，按照美国国立卫生研究所中风量表进行神经功能缺损程度评估；对缺血性脑卒中患者血浆Lp-PLA2与神经功能缺损程度评分进行相关性分析。结果缺血性脑卒中组、出血性脑卒中组和正常对照组之间Lp-PLA2、TC、HDL-C、LDL-C、FIB水平差异均有统计学意义（P均＜0．05）；缺血性脑卒中组与出血性脑卒中组之间TG和Glu水平差异无统计学意义（P值分别为0．133、0．067），但与正常对照组比较差异有统计学意义（P均＜0．05）。血浆Lp-PLA2诊断缺血性脑卒中的ROC曲线下面积为（AUC）为0．905、最佳临界点为42．35μg/L、敏感性为81．5％、特异性为80．0％。血浆Lp-PLA2水平随脑梗死体积增加而呈递增趋势，但差异无统计学意义（H＝0．372，P＝0．719）。Spearman相关分析显示缺血性脑卒中患者血浆Lp-PLA2水平与神经功能缺损程度评分密切相关（P均＜0．05）。结论缺血性脑卒中患者血浆Lp-PLA2水平明显升高，与神经功能缺损程度评分密切相关。Lp-PLA2是缺血性脑卒中发病的独立危险因子，可成为缺血性脑卒中的预测指标和评价病情严重程度的重要指标。