血清ICAM-1、hs-CRP及MCP-1与急性脑梗死病人颈动脉斑块性质的相关性

目的探讨血清细胞间黏附分子（ICAM-1）、超敏C反应蛋白（hs-CRP）、单核细胞趋化蛋白-1（MCP-1）与急性脑梗死（ACI）病人颈动脉斑块性质的相关性。方法选择105例ACI病人作为研究对象，收集病人临床资料，酶联免疫法测定检测血清hs-CRP、MCP-1水平，双抗体夹心酶联免疫法检测血清ICAM-1水平，颈动脉超声检测颈动脉内-中膜厚度（IMT）和颈动脉斑块性质，根据IMT值将病人分为0.9 mm < IMT ≤ 1.2 mm、1.2 mm < IMT ≤ 1.4 mm、IMT>1.4 mm 3个亚组，根据斑块性质将病人分为稳定性斑块组（39例）和易损斑块组（66例）。Pearson相关分析分析血清ICAM-1、hs-CRP、MCP-1水平与IMT相关性。多元logistic回归分析分析影响ACI颈动脉粥样硬化斑块不稳定的危险因素，受试者工作特征曲线（ROC）分析血清ICAM-1、hs-CRP、MCP-1水平预测ACI病人颈动脉粥样硬化斑块不稳定的价值。结果易损斑块组血清ICAM-1、hs-CRP、MCP-1水平均高于稳定性斑块组（P < 0.01）。血清ICAM-1、hs-CRP、MCP-1水平在0.9 mm < IMT ≤ 1.2 mm组、1.2 mm < IMT ≤ 1.4 mm组、IMT>1.4 mm组依次升高（P < 0.05~P < 0.01）。Pearson相关分析结果显示血清ICAM-1、hs-CRP、MCP-1水平与IMT呈正相关（r=0.495、0.585、0.498，P < 0.05）。多元logistic回归分析结果显示高水平ICAM-1、hs-CRP、MCP-1及LDL-C、合并糖尿病是ACI病人颈动脉斑块性质不稳定的危险因素（P < 0.01）。ROC分析结果显示血清ICAM-1、hs-CRP、MCP-1及三者联合预测ACI病人颈动脉粥样硬化斑块不稳定的曲线下面积分别为0.722、0.753、0.646、0.852，灵敏度分别为69.23%、79.49%、66.67%、89.74%，特异度分别为74.24%、68.18%、65.15%、89.39%。结论血清ICAM-1、hs-CRP、MCP-1水平与ACI病人颈动脉粥样硬化斑块性质有关，可能作为颈动脉斑块不稳定的预测因子。

Correlation between serum ICAM-1, hs-CRP and MCP-1 and carotid plaque in patients with acute cerebral infarction

ObjectiveTo investigate the correlations between serum intercellular adhesion molecule-1(ICAM-1), hypersensitive C reactive protein(hs-CRP), monocyte chemoattractant protein-1(MCP-1) and carotid artery plaque in patients with acute cerebral infarction(ACI).MethodsOne hundred and five ACI patients were admitted, the patients' clinical data were collected, the levels of serum hs-CRP and ICAM-1 were detected by ELISA and serum MCP-1 level was detected by double antibody sandwich ELISA, and the carotid intima-media thickness(IMT) and the characteristics of carotid artery plaque were measured by carotid ultrasound.The patients were subdivided into 0.9 mm < IMT ≤ 1.2 mm group, 1.2 mm < IMT ≤ 1.4 mm group, IMT>1.4 mm group, and also divided into the stability plaque group(39 cases) and vulnerable plaque group(66 cases) according to the characteristics of the plaques.The correlations between serum hs-CRP, ICAM-1, MCP-1 and IMT were analyzed by Pearson correlation analysis.The risk factors influencing the ACI carotid atherosclerotic plaque instability were analyzed by multiple logistic regression analysis, and the value of serum hs-CRP, ICAM-1, MCP-1 levels in predicting the carotid atherosclerotic plaque instability in ACI patients were analyzed by the receiver operating characteristic(ROC) curve.ResultsThe levels of serum hs-CRP, ICAM-1 and MCP-1 in vulnerable plaques group were higher than those in stability plaque group(P < 0.01).The levels of serum hs-CRP, ICAM-1 and MCP-1 were increased successively in the 0.9 mm < IMT ≤ 1.2 mm group, 1.2 mm < IMT ≤ 1.4 mm group, and IMT>1.4 mm group(P < 0.05 to P < 0.01).Pearson correlation analysis showed that serum hs-CRP, ICAM-1 and MCP-1 levels were positively correlated with IMT(r=0.495, 0.585, 0.498, P < 0.05).Multiple logistic regression analysis showed that the high levels of ICAM-1, hs-CRP, MCP-1, LDL-C and diabetes mellitus were the risk factors for carotid plaque instability in ACI patients(P < 0.01).ROC analysis showed that serum hs-CRP, ICAM-1 and MCP-1 levels and the combinations of the three factors which predicted the area under the curve(AUC) of carotid atherosclerotic plaque instability in ACI patients were 0.722, 0.753, 0.646 and 0.852, respectively.The sensitivity was 69.23%, 79.49%, 66.67% and 89.74%, and the specificity was 74.24%, 68.18%, 65.15% and 89.39%, respectively.ConclusionsSerum ICAM-1, hs-CRP and MCP-1 levels are related to the characteristics of carotid atherosclerotic plaque in ACI patients, which may be used as the predictors of carotid plaque instability.