南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (2): 317-322.doi: 10.12122/j.issn.1673-4254.2023.02.22

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血清脂蛋白相关磷脂酶A2水平与伴高血压的急性缺血性脑梗死复发正相关

梁丽冰，陈静娟，章成国，王玉凯，罗柏桂，周天恩，王晓锋   

  1. 南方医科大学第三附属医院神经内科，广东 广州 510630；佛山市第一人民医院急诊科，神经内科，科教科，广东 佛山 528000
  • 出版日期:2023-02-20 发布日期:2023-03-16

Serum lipoprotein-associated phospholipase A2 level is positively correlated with the recurrence risk of acute ischemic cerebral infarction in hypertensive patients

LIANG Libing, CHEN Jingjuan, ZHANG Chengguo, WANG Yukai, LUO Baigui, ZHOU Tianen, WANG Xiaofeng   

  1. Department of Neurology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; Department of Emergency Medicine, Department of Neurology, Science and Education Department, The Foshan First People's Hospital, Foshan 528000, China
  • Online:2023-02-20 Published:2023-03-16

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摘要： 目的 探究在伴高血压的急性缺血性脑卒中（AIS）患者中，血清脂蛋白相关磷脂酶A2（Lp-PLA2）浓度及复发风险之间的相关性。方法 采用回顾性病例对照研究，纳入211例确诊伴高血压的急性脑梗死患者，入院24 h内检测血清Lp-PLA2浓度,对纳入研究的患者进行1年随访观察，根据头颅CT/MR证实脑梗死复发而分为复发组（35例）和非复发组（176例），根据高血压分级分为3组，分别为1 级高血压组（60例，复发5例）、2 级高血压组（76例，复发11例）、3 级高血压组（75例，复发19例）。单因素分析两组间的临床资料及Lp-PLA2浓度，采用多因素logistic回归分析、趋势性分析、平滑曲线拟合分析血清Lp-PLA2浓度与伴高血压的急性脑梗死复发风险的相关性，采用ROC曲线对不同高血压分级伴AIS中Lp-PLA2浓度与复发风险进行预测效能评价。结果 与非复发组对比，复发组中血清Lp-PLA2浓度、年龄、入院时NHISS评分、7 d时mRS评分、HCY、吸烟间的差异有统计学意义（P<0.05）。多因素回归分析中，当调整混杂因素后，与Lp-PLA2最低三分位组相比，Lp-PLA2最高三分位组的复发风险增加了4.13倍（OR=5.13，95% CI：1.35~19.40），而当Lp-PLA2作为连续变量时，Lp-PLA2每增加1 ng/mL，伴高血压的缺血性脑卒中患者复发风险增加1%( OR=1.01 95% CI：1.01~1.02）。平滑曲线显示Lp-PLA2浓度与高血压合并脑梗死的复发风险呈正相关。Lp-PLA2浓度预测3级高血压伴AIS患者复发风险的ROC曲线下面积为0.869，特异度为0.893，敏感度为0.737。结论 血清Lp-PLA2浓度是伴高血压的急性脑梗死患者复发风险的独立危险因素，且可能是3级高血压伴AIS复发风险的有效预测指标。

关键词: 脂蛋白相关磷脂酶A2；伴高血压的脑梗死；复发；脑梗死

Abstract: Objective To explore the relationship between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level and the risk of acute ischemic stroke (AIS) recurrence in hypertensive patients. Methods This retrospective case-control study was conducted among 211 hypertensive patients with AIS treated in Foshan First People's Hospital, including 35 patients with recurrence of AIS during the 1-year follow-up as confirmed by head CT/MR. In the overall patients, 60 had grade 1 hypertension (including 5 recurrent cases), 76 had grade 2 hypertension (with 11 recurrent cases), and 75 had grade 3 hypertension (with 19 recurrent cases). Univariate analysis, multivariate logistic regression analysis, trend analysis, and smooth curve fitting analysis were performed to explore the correlation between serum Lp-PLA2 level within 24 h after admission and the risk of AIS recurrence. The predictive efficacy of serum Lp-PLA2 level for AIS recurrence in different hypertension grades was evaluated using ROC curve analysis. Results Serum Lp-PLA2 level, age, NIHSS score at admission, mRS scores at 7 days, homocysteine level and smoking status differed significantly between patients with and without AIS recurrence (P<0.05). After adjustment for confounding factors, multivariate regression analysis showed that the highest tertile of Lp-PLA2 level was associated with a 4.13- fold increase of AIS recurrence risk compared with the lowest tertile (OR=5.13, 95% CI: 1.35-19.40), and each 1 ng/mL increase of Lp-PLA2 level was associated with a 1% increase of AIS recurrence risk (OR=1.01, 95% CI: 1.01-1.02). Serum Lp-PLA2 level was shown to positively correlate with AIS recurrence risk, and in patients with grade 3 hypertension, its areas under the ROC curve for predicting AIS recurrence was 0.869 with a specificity of 0.893 and a sensitivity of 0.737. Conclusion Serum Lp-PLA2 concentration is an independent risk factor and potentially an effective predictor for AIS recurrence in patients with grade 3 hypertension.

Key words: lipoprotein-associated phospholipase A2; ischemic stroke with hypertension; recurrence; correlation analysis