血浆Lp-PLA2、幽门螺杆菌感染对颈动脉粥样硬化的影响分析

目的探究血浆脂蛋白相关磷脂酶A2(Lp-PLA2)、幽门螺杆菌(Hp)感染对颈动脉粥样硬化(CA)的影响。方法回顾性分析2016年10月至2018年9月湖北三峡职业技术学院附属医院收治的134例CA患者临床资料,根据颈动脉狭窄程度分为重度组(n=38)、中度组(n=52)与轻度组(n=44),再根据颈动脉斑块稳定性分为不稳定组(n=58)与稳定组(n=76),另纳入65例同期接受健康检查而未诊断出CA的受试者为对照组。比较各组血浆LpPLA2水平及Hp感染情况差异,采用Pearson或Spearman相关系数模型,分析颈动脉狭窄程度、斑块稳定性与血浆LpPLA2水平、Hp感染率的相关性,通过受试者工作特征(ROC)曲线评估血浆Lp-PLA2水平与Hp感染率对CA的预测价值。结果重度组、中度组、轻度组、对照组血浆Lp-PLA2水平分别为(71.58±18.81)、(57.32±15.04)、(46.65±13.47)、(38.53±12.02) ng/mL,Hp感染率分别为89.47%、76.92%、56.82%、44.62%,血浆Lp-PLA2水平结果从高到低依次为重度组、中度组、轻度组、对照组,组间差异均有统计学意义(P <0.05);中、重度组Hp感染率均明显高于轻度组与对照组(P <0.05)。不稳定组、稳定组、对照组血浆Lp-PLA2水平分别为(64.26±18.27)、(52.98±14.66)、(38.53±12.02) ng/mL,Hp感染率分别为87.93%、63.15%、44.62%。血浆Lp-PLA2水平及Hp感染率结果从高到低依次为不稳定组、稳定组、对照组,组间差异均有统计学意义(P <0.05)。颈动脉狭窄程度与血浆Lp-PLA2水平、Hp感染率呈显著正相关性(r=0.615、0.377,P <0.05);颈动脉斑块稳定性与血浆Lp-PLA2水平、Hp感染率均呈显著负相关性(r=-0.578、-0.35,P <0.05)。血浆Lp-PLA2、Hp感染率预测CA所得ROC曲线下面积分别为0.825、0.646,均明显大于参考线(P <0.05),敏感度分别为68.7%、73.9%,特异度分别为87.2%、55.3%,得出血浆LpPLA2预测CA的cut-off值为50.50 ng/mL。结论血浆Lp-PLA2水平、Hp感染率可对CA发生及病情进展产生较大影响,均有较高临床检测价值。

Analysis of effects of plasma Lp-PLA2 and Helicobacter pylori infection on carotid atherosclerosis

Objective To explore the effects of plasma lipoprotein-associated phospholipase A2(Lp-PLA2)and Helicobacter pylori(Hp)infection on carotid atherosclerosis(CA).Methods The clinical data of 134 CA patients admitted to the Affiliated Hospital of Hubei Three Gorges Vocational and Technical College from October 2016 to September 2018 were retrospectively analyzed.According to the degree of carotid stenosis,they were divided into severe group(n=38),moderate group(n=52)and mild group(n=44),and then they were divided into unstable group(n=58)and stable group(n=76)according to carotid plaque stability.Another 65 subjects who received health check at the same time and did not diagnose CA were included in control group.The differences of plasma Lp-PLA2 level and Hp infection were compared between the groups.Pearson or Spearman correlation coefficient model was used to analyze the correlation between carotid stenosis degree,plaque stability and plasma Lp-PLA2 level and Hp infection rate.The receiver operating characteristic(ROC)curves were used to assess the predictive value of plasma Lp-PLA2 level and Hp infection rate for CA.Results The levels of plasma Lp-PLA2 in severe group,moderate group,mild group and control group were(71.58±18.81),(57.32±15.04),(46.65±13.47),(38.53±12.02)ng/mL,and Hp infection rates were 89.47%,76.92%,56.82%,44.62%,respectively.The results of plasma Lp-PLA2 levels from high to low were severe group,moderate group,mild group,and control group,the differences between the groups were statistically significant(P<0.05).The Hp infection rates in moderate group and severe group were significantly higher than those in mild group and control group(P<0.05).The levels of plasma Lp-PLA2 in the unstable group,stable group and control group were(64.26±18.27),(52.98±14.66),(38.53±12.02)ng/mL,respectively,and the Hp infection rates were 87.93%,63.15%,44.62%,respectively.The results of plasma Lp-PLA2 level and Hp infection rate from high to low were unstable group,stable group,control group,the differences between the groups were statistically significant(P<0.05).Carotid stenosis degree was significantly positively correlated with plasma Lp-PLA2 level and Hp infection rate(r=0.615,0.377,P<0.05).Carotid plaque stability was significantly negatively correlated with plasma Lp-PLA2 level and Hp infection rate(r=-0.578,-0.35,P<0.05).The AUC values of ROC curve of plasma Lp-PLA2 and Hp infection rate were 0.825 and 0.646 respectively in predicting CA,which were significantly higher than the reference line(P<0.05).And the sensitivities were 68.7%and 73.9%,and specificities were 87.2%and 55.3%respectively,and the cut-off value of plasma Lp-PLA2 in predicting CA was 50.50 ng/mL.Conclusion Plasma Lp-PLA2 level and Hp infection rate can have a great impact on the occurrence and progression of CA,and have high clinical detection value.