急性缺血性脑卒中患者血浆Lp-PLA2水平与颈动脉硬化斑块稳定性及神经功能缺损程度的关系

目的探讨血浆脂蛋白相关磷脂酶A2（Lp—PLA2）水平与急性缺血性脑卒中患者颈动脉粥样硬化斑块稳定性及神经功能缺损程度的关系。方法将106例急性缺血性脑卒中患者根据颈动脉彩超检查分为不稳定斑块组（44例）、稳定型斑块组（38例）和无斑块组（24例），以40名健康体检者作为正常对照组，采用酶联免疫吸附试验（ELISA）测定血浆Lp—PLA2水平。所有患者按美国国立卫生研究所中风量表（NIHSS评分）进行神经功能缺损程度评估。结果急性缺血性脑卒中患者Lp—PLA2水平明显高于正常对照组（Z=-6．995，P〈0．05）；无斑块组、稳定型斑块组和不稳定斑块组Lp—PLA2水平依次升高，且无斑块组与有斑块组比较差异有统计学意义（Z=-5．670，P〈0．05），稳定型斑块组和不稳定斑块组比较差异有统计学意义（Z=-6．185，P〈0．05）。受试者工作特征（ROC）曲线显示Lp—PLA2评估急性缺血性脑卒中患者斑块稳定性的最佳截断值为137．00μg/L，灵敏度为81．8％，特异性为95．1％。神经功能缺损程度随Lp．PLA2水平的增加呈递增趋势，差异有统计学意义（x^2=74．233，P〈0．05）。血浆Lp—PLA2水平与NIHSS评分呈明显正相关（0=0．861，P〈0．05）。结论急性缺血性脑卒中患者Lp—PLA2水平与颈动脉粥样硬化斑块稳定性和神经功能缺损程度有关，血浆Lp—PLA2水平可预测斑块稳定性，同时对急性缺血性脑卒中患者的病情监测有重要价值。

The relationship of plasma Lp-PLA2 level with the stability of carotid artery atherosclerotic plaque and the severity of neurological impairment in patients with acute ischemic stroke

Objective To investigate the relationship of plasma lipoprotein-associated phospholipase A2 （Lp-PLA2） level with the stability of carotid artery atherosclerotic plaque and the severity of neurological impairment in patients with acute ischemic stroke. Methods According to the results of cervical vascular color Doppler ultrasound examination, 106 patients with acute ischemic stroke were classified into unstable plaque group（44 cases）, stable plaque group（38 cases） and non-plaque group （24 cases）. A total of 40 healthy subjects were enrolled as healthy controls. Plasma Lp-PLA2 levels were determined by enzyme-linked immunosorbent assay （ ELISA）, and the severity of neurological impairment were assessed by the National Institute of Health Stroke Scale （NIHSS） score. Results Compared with the healthy controls,the level of plasma Lp-PLA2 was significantly higher in patients with acute ischemic stroke （Z = -6. 995 ,P 〈 0.05 ）. Plasma levels of Lp-PLA2 in stable plaque group and unstable plaque group were significantly higher than those in non-plaque group with statistical significance （ Z = - 5. 670,P 〈 0.05 ）. Plasma levels of Lp-PLA2 in unstable plaque group were significantly higher than those in stable plaque group with statistical significance （Z = -6. 185 ,P 〈 0.05 ）. According to the results of receiver operating characteristic （ROC） curve, the best cut-off value of Lp-PLA2 was 137.00 jxg/L. The sensitivity was 81.8%, and the specificity was 95. 1%. The severity of neurological impairment increased with the levels of plasma Lp-PLA2（x2 =74. 233 ,P 〈 0.05 ）. The NIHSS score was positively correlated with the levels of plasma Lp-PLA2 （ rs = 0. 861, P 〈 0.05 ）. Conclusions The level of plasma Lp-PLA2 is related to the stability of carotid artery atherosclerotic plaque and the severity of neurological impairment in patients with acute ischemic stroke. Plasma Lp-PLA2 can serve as a predictive indicator of carotid artery atherosclerotic plaque stability Meanwhile,it plays an important role in monitoring the conditions of patients with acute ischemic stroke.