摘要
目的分析血清脂蛋白相关磷脂酶A2(Lp-PLA2)水平对动脉粥样硬化性脑梗死患者预后的预测价值。方法选取南京上海梅山医院2014年3月—2016年3月收治的动脉粥样硬化性脑梗死患者118例,出院后随访12个月,根据随访结果分为预后良好组78例和预后不良组40例。比较两组患者临床特征和实验室检查指标;动脉粥样硬化性脑梗死患者预后的影响因素分析采用多因素Logistic回归分析,绘制ROC曲线以评价血清Lp-PLA2水平对动脉粥样硬化性脑梗死患者预后的预测价值,不同血清Lp-PLA2水平患者无事件生存率比较采用log-rank检验。结果两组患者年龄、男性比例、体质指数、糖尿病发生率、高血压发生率、高脂血症发生率、吸烟史、饮酒史、收缩压、舒张压、空腹血糖(FPG)及血清脂蛋白a(Lp-a)、纤维蛋白原(FIB)水平比较,差异无统计学意义(P>0.05);预后良好组患者白细胞计数(WBC)及血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)、Lp-PLA2水平低于预后不良组,血清高密度脂蛋白胆固醇(HDL-C)水平高于预后不良组(P<0.05)。多因素Logistic回归分析结果显示,血清Lp-PLA2水平是动脉粥样硬化性脑梗死患者预后不良的独立危险因素[OR=2.106,95%CI(1.105,3.352),P<0.05]。血清Lp-PLA2水平预测动脉粥样硬化性脑梗死患者预后的曲线下面积为0.845[95%CI(0.776,0.914)],最佳截断值为51.50μg/L,灵敏度为0.950,特异度为0.641。随访12个月,血清Lp-PLA2水平>51.50μg/L者无事件生存率低于血清Lp-PLA2水平≤51.50μg/L者(P<0.05)。结论血清Lp-PLA2水平对动脉粥样硬化性脑梗死患者预后具有一定预测价值,且血清Lp-PLA2水平>51.50μg/L患者脑梗死复发或死亡风险较高,应引起临床重视。
Objective To analyze the predictive value of serum Lp-PLA2 level on prognosis in patients with atherosclerotic cerebral infarction. Methods A total of 118 patients with atherosclerotic cerebral infarction were selected in Shanghai Meishan Hospital of Nanjing from March 2014 to March 2016, and they were divided into A group（ with good prognosis,n = 78） and B group（ with poor prognosis,n = 40） according to the 12-month follow-up results. Clinical features and laboratory examination results were compared between the two groups; influencing factors of prognosis in patients with atherosclerotic cerebral infarction were analyzed by multivariate Logistic regression analysis,meanwhile ROC curve was drawn to evaluate the predictive value of serum Lp-PLA2 level on the prognosis,and log-rank test was used to compare the event free survival rate in patients with different serum Lp-PLA2 levels. Results No statistically significant differences of age, male proportion,BMI,incidence of diabetes, hypertension or hyperlipidaemia, smoking history, drinking history, SBP, DBP,FPG,serum level of Lp-a or FIB was found between the two groups（ P〈0. 05）; WBC,serum levels of TG,TC,LDL-C,hs-CRP and Lp-PLA2 of A group were statistically significantly lower than those of B group,while serum HDL-C level of A group was statistically significantly higher than that of B group（ P〈0. 05）. Multivariate Logistic regression analysis results showed that,serum Lp-PLA2 level was the independent risk factor of poor prognosis in patients with atherosclerotic cerebral infarction[OR = 2. 106,95% CI（ 1. 105,3. 352）,P〈0. 05]. AUC of serum Lp-PLA2 level in predicting the prognosis in patients with atherosclerotic cerebral infarction was 0. 845 [95% CI（ 0. 776,0. 914） ], the best cut-off value was 51. 50 μg/L, the sensitivity was 0. 950,the specificity was 0. 641. During the 12-month follow-up,event free survival rate if patients with serum Lp-PLA2 level over 51. 50 μg/L was statistically significantly lower than that of patients with serum Lp-PLA2 level equal or below 51. 50 μg/L（ P〈0. 05）. Conclusion Serum Lp-PLA2 level has certain predictive value on prognosis in patients with atherosclerotic cerebral infarction,patients with serum Lp-PLA2 level over 51. 50 μg/L have relatively high risk of relapse and death,which should pay more attentions to.
出处
《实用心脑肺血管病杂志》
2017年第10期37-41,共5页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
脑梗死
动脉粥样硬化
脂蛋白相关磷脂酶A2
预后
预测
Brain infarction
Atherosclerosis
Lipoprotein - associated phospholipase A2
Prognosis
Forecasting
