钱小燕;王万华;鲍治诚;陆丽芸;张蕾;唐晴;缪桂华;王红洲;张炎;

• 1:江苏大学附属昆山医院

摘要(Abstract)：

目的探讨血浆脂蛋白磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)水平与急性脑梗死(acute cerebral infarction,ACI)患者病情严重程度及预后的相关性。方法选取2017—2019年江苏大学附属昆山医院神经内科住院的207例急性脑梗死患者,检测Lp-PLA2及高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、脂蛋白a[LP(a)]、同型半胱氨酸水平(Hcy),详细记录患者有无高血压史、糖尿病史、吸烟、饮酒史。采用美国国立卫生研究所卒中量表评分(NIHSS)评估脑梗死严重程度,通过患者3个月的改良Rankin量表(mRS)评分评估其短期预后,分析LP-PLA2水平与脑梗死严重程度与预后的相关性。结果 Lp-PLA2(OR=1.016,95%CI:1.011～1.021,P<0.01)、LDL(OR=1.574,95%CI:1.137～2.178,P=0.006)、Hcy(OR=1.044,95%CI:1.008～1.082,P=0.017)、年龄(OR=1.071,95%CI:1.041～1.101,P<0.01)、吸烟(OR=0.256,95%CI:0.139～0.471,P<0.01)为脑梗死患者病情严重程度的独立危险因素,性别、饮酒、高血压史、糖尿病史、HDL、LP(a)则差异无统计学意义(P>0.05)。Lp-PLA2(OR=1.03,95%CI:0.986～1.067,P<0.01)、吸烟(OR=0.397,95%CI:0.16～0.984,P=0.046)、脑梗死病情的严重程度(OR=0.04,95%CI:0.009～0.167,P<0.01)是影响脑梗死预后的独立危险因素。结论除传统的吸烟、LDL、Hcy、年龄危险因素外,Lp-PLA2亦是影响脑梗死患者病情严重程度的独立危险因素,且影响脑梗死患者的预后。Lp-PLA2或可作为标志物用于预测脑梗死病情严重程度及预后。

关键词(KeyWords)： 脑梗死;严重程度;Lp-PLA2;相关性;预后

Abstract:

Keywords:

基金项目(Foundation): 昆山市社会发展科技专项(编号:KS1665)

作者(Authors): 钱小燕;王万华;鲍治诚;陆丽芸;张蕾;唐晴;缪桂华;王红洲;张炎;

参考文献(References)：

• [1] FURIE K L,KASNER S E,ADAMS R J,et al.Correction to:Guidelines for the Early Management of Patients With Acute Ischemic Stroke:2019 Update to the 2018Guidelines for the Early Management of Acute Ischemic Stroke:A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J].Stroke,2019,50(12):e440-e441.DOI:10.1161/STR.0000000000000215.
• [2] HU G,LIU D,TONG H,et al.Lipoprotein-Associated Phospholipase A2 Activity and Mass as Independent Risk Factor of Stroke:A Meta-Analysis[J].Biomed Res Int,2019:8642784.DOI:10.1155/2019/8642784.
• [3] PHAN T G,CLISSOLD B,LY J,et al.Stroke Severity and Comorbidity Index for Prediction of Mortality after Ischemic Stroke from the Virtual International Stroke Trials Archive-Acute Collaboration[J].J Stroke Cerebrovasc Dis,2016,25(4):835-842.DOI:10.1016/j.jstrokecerebrovasdis.2015.12.016.
• [4] TAO L,SHICHUAN W,DETAI Z,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,2019Nov 11:e23084.DOI:10.1002/jcla.23084.
• [5] ZHANG H,ZHOU W,CAO C,et al.Amelioration of atherosclerosis in apolipoprotein E-deficient mice by combined RNA interference of lipoprotein-associated phospholipase A2and YKL-40[J].PLoS One,2018,13(8):e0202797.DOI:10.1371/journal.pone.0202797.
• [6] LIU H,YAO Y,WANG Y,et al.Association between high-sensitivity C-reactive protein,lipoprotein-associated phospholipase A2and carotid atherosclerosis:A crosssectional study[J].J Cell Mol Med,2018,22(10):5145-5150.DOI:10.1111/jcmm.13803.
• [7] TSELEPIS A D.Oxidized phospholipids and lipoproteinassociated phospholipase A2as important determinants of Lp(a)functionality and pathophysiological role[J].J Biomed Res,2016 Apr 2:31.DOI:10.7555/JBR.31.20160009.
• [8] WEI L,KE Z,ZHAO Y,et al.The elevated lipoproteinassociated phospholipase A2activity is associated with the occurrence and recurrence of acute cerebral infarction[J].Neuroreport,2017,28(6):325-330.DOI:10.1097/WNR.0000000000000765.
• [9] ELKIND M S,TAI W,COATES K,et al.Hihgsensitivity C-reactiveprotein,Lipoprotein-associated Phospholipase A2,and outcome after ischemic stroke[J].Arch Intern Med,2006,166(19):2073-2080.DOI:10.1001/archinte.166.19.2073.
• [10] OEI H H,VAN DER MEER I M,HOFMAN A,et al.Lipoprotein-associated phospholipase A2activity is associated with risk of coronary heart disease and ischemic stroke:the Rotterdam Study[J].Circulation,2005,111(5):570-575.DOI:10.1161/01.CIR.0000154553.12214.CD.
• [11] YANG L,CONG H L,WAN G S F,et al.AMPactivated protein kinase mediates the effects of lipoprotein-associated phospholipase A2on endothelial dysfunction in atherosclerosis[J].Exp Ther Med,2017,13(4):1622-1629.DOI:10.3892/etm.2017.4142.
• [12] THOMPSON A,GAO P,ORFEI L,et al.Lipoproteinassociated phospholipase A(2)and risk of coronary disease,stroke,and mortality:collaborative analysis of32prospective studies[J].Lancet,2010,375(9725):1536-1544.DOI:10.1016/S0140-6736(10)60319-4.
• [13] LI J,WANG H,TIAN J,CHEN B,et al.Change in lipoprotein-associated phospholipase A2and its association with cardiovascular outcomes in patients with acute coronary syndrome[J].Medicine(Baltimore),2018,97(28):e11517.DOI:10.1097/MD.0000000000011517.
• [14]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.中国急性缺血性卒中诊治指南2018[J].中华神经科杂志,2018,51(9):666-682.
• [15] LEACH C A,HIEKEY D M,IFE R J,et al.Lipoprotein-associated PLA2 inhibition-a novel,nonlipid lowering strategy for atherosclerosis therapy[J].Farmaco,2001,56:45.DOI:10.1016/s0014-827x(01)01011-4.
• [16] ESENWA C C,ELKIND M S.Inflammatory risk factors,biomarkers and associated therapy in ischaemic stroke[J].Nat Rev Neurol,2016,12(10):594-604.DOI:10.1038/nrneurol.2016.125.
• [17] LIU X,ZHU R X,TIAN Y L,et al.Association of PLA2G7gene polymorphisms with ischemic stroke in northern Chinese Han population[J].Clin Biochem,2014,47:404-408.DOI:10.1016/j.clinbiochem.2014.01.010.
• [18] BURCHARDT P,ZURAWSKI J,ZUCHOWSKI B,et al.Low-density lipoprotein,its susceptibility to oxidation and the role of lipoprotein-associated phospholipase A2and carboxyl ester lipase lipases in atherosclerotic plaque formation[J].Arch Med Sci,2013,9:151-158.DOI:10.5114/aoms.2013.33176.
• [19]叶芸,李苏亮.脑卒中患者血浆Lp-PLA2水平及临床意义探讨[J].检验医学,2014,29(3):249.
• [20] KIM M,YOO H J,KO J,et al.Metabolically unhealthy overweight individuals have high lysophosphatide levels,phospholipase activity,and oxidative stress[J].Clin Nutr,2019 Apr 25.pii:S0261-5614(19)30201-8.DOI:10.1016/j.clnu.2019.04.025.
• [21] WANG Y,HU S,REN L,et al.Lp-PLA2as a risk factor of early neurological deterioration in acute ischemic stroke with TOAST type of large arterial atherosclerosis[J].Neurol Res,2019,41(1):1-8.DOI:10.1080/01616412.2018.1493850.
• [22] ZHOU F,LIU Y,SHI H,et al.Relation between lipoprotein-associated phospholipase A2mass and incident ischemic stroke severity[J].Neurol Sci,2018,39(9):1591-1596.DOI:10.1007/s10072-018-3474-3.
• [23] KARA H,AKINCI M,DEGIRMENCI S,et al.Highsensitivity C-reactive protein,lipoprotein-related phospholipase A2,and acute ischemic stroke[J].Neuropsychiatr Dis Treat,2014:1451-1457.DOI:10.2147/NDT.S67665.
• [24]王金松.急性脑梗死血清Hcy和hs-CRP的变化及与病情的相关性研究[J].中国实用神经疾病杂志,2018,21(6):619-621.
• [25] KWON H M,LEE Y S,BAE H J,et al.Homocysteine as a predictor of early neurological deterioration in acute ischemic stroke[J].Stroke,2014,45(3):871-873.DOI:10.1161/STROKEAHA.113.004099.