脂蛋白相关磷脂酶A2与中老年高血压患者颈动脉不稳定斑块的关系

doi:10.3969/j.issn.1004-583X.2021.02.003

摘要/Abstract

摘要：

目的探讨血浆脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)活性水平与中老年高血压患者颈动脉不稳定斑块的关系及其临床意义。方法选取高血压患者102例行双侧颈动脉超声检查,依据超声影像、斑块形态和回声特征综合评价分为两组:稳定斑块组50例、不稳定斑块组52例。用酶活性法测定患者血浆Lp-PLA2活性水平。分析颈动脉不稳定斑块的影响因素,血浆Lp-PLA2活性水平对颈动脉不稳定斑块的预测价值。结果不稳定斑块组血浆Lp-PLA2活性水平高于稳定斑块组(P<0.05)。血浆Lp-PLA2活性水平是影响中老年高血压患者颈动脉不稳定斑块的独立危险因素(P<0.05)。Lp-PLA2预测颈动脉不稳定斑块的ROC曲线下的面积(AUC)为0.921,最佳临界值为551.15 U/L时,其预测的灵敏度为75%,特异度为94%。结论血浆Lp-PLA2活性水平于中老年高血压颈动脉不稳定斑块患者中明显升高,是其独立的危险因素。血浆Lp-PLA2活性水平对颈动脉不稳定斑块有较高的预测价值,其值为551.15 U/L时可辅助预测斑块稳定与否,有望成为临床早期评估脑血管栓塞性事件的预警性炎性标志物。

关键词: 磷脂酶A2, 高血压, 颈动脉斑块

Abstract:

Objective To explore and analyze the relations between the activity level of plasma lipoprotein-associated phospholipase A2(Lp-PLA2) and unstable carotid atherosclerotic plaque in middle-aged or elderly patients with hypertension and corresponding clinical significance. Methods One hundred and two patients with hypertension were selected to undergo bilateral carotid ultrasound examinations and were divided into two groups including 50 cases in stable carotid atherosclerotic plaque and 52 cases in unstable carotid atherosclerotic plaque based on the comprehensive evaluation involving ultrasound images, plaque morphology and echo characteristics. The enzyme activity method was used to determine the activity level of plasma Lp-PLA2 in patients, and the influencing factors of unstable carotid atherosclerotic plaque and predictive value of activity level of plasma Lp-PLA2 on unstable carotid atherosclerotic plaque were analyzed. Results The activity level of plasma Lp-PLA2 activity in the patients in unstable carotid atherosclerotic plaque group was higher than that in in patients in the stable carotid atherosclerotic plaque group (P<0.05). The activity level of plasma Lp-PLA2 activity isserved as an independent risk factor affecting unstable carotid atherosclerotic plaque in middle-aged and or elderly hypertensive patients (P<0.05). The area under the ROC curve (AUC) of Lp-PLA2 predicting unstable carotid atherosclerotic plaque was 0.921, and when the best cut-off value was 551.15 U/L, its prediction sensitivity was 75% and specificity was 94%. Conclusion The activity level of plasma Lp-PLA2 is significantly elevated in middle-aged or elderly patients with hypertension complicated with unstable carotid atherosclerotic plaque, and it is considered to be an independent risk factor. The activity level of Plasma Lp-PLA2 delivers high predictive value for unstable carotid atherosclerotic plaque. When its value is 551.15 U/L, it can help predict whether the plaque is stable, and it is expected to be an inflammatory marker for early warning on early clinical evaluation of cerebrovascular embolic events.

Key words: phospholipases a2, hypertension, carotid plaque

中图分类号:

R345.61

邓余杰, 范林清, 张涛. 脂蛋白相关磷脂酶A2与中老年高血压患者颈动脉不稳定斑块的关系[J]. 临床荟萃, 2021, 36(2): 112-116.

Deng Yujie, Fan Linqing, Zhang Tao. Relations between lipoprotein-associated phospholipase A2 and unstable carotid atherosclerotic plaque in middle-aged or elderly patients with hypertension[J]. Clinical Focus, 2021, 36(2): 112-116.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.02.003

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I2/112

图/表 4

参考文献 21

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组别	例数	性别(例)		年龄 (岁)	体重 (kg)	吸烟史 (例)	饮酒史 (例)	高血压病程 (年)	收缩压 (mmHg)	舒张压 (mmHg)
组别	例数	男	女	年龄 (岁)	体重 (kg)	吸烟史 (例)	饮酒史 (例)	高血压病程 (年)	收缩压 (mmHg)	舒张压 (mmHg)
稳定斑块组	50	24	26	59.72±7.64	64.76±7.59	32	26	13.96±3.16	160.10±14.39	98.84±12.91
不稳定斑块组	52	26	26	59.71±7.61	67.60±6.59	39	32	15.87±4.71	163.85±22.78	99.10±9.78
t/χ²值		0.041		0.006	-2.017	1.458	0.945	-2.408	-0.997	-0.113
P值		0.840		0.996	0.046	0.227	0.331	0.018	0.322	0.911

组别	例数	性别(例)		年龄 (岁)	体重 (kg)	吸烟史 (例)	饮酒史 (例)	高血压病程 (年)	收缩压 (mmHg)	舒张压 (mmHg)
组别	例数	男	女	年龄 (岁)	体重 (kg)	吸烟史 (例)	饮酒史 (例)	高血压病程 (年)	收缩压 (mmHg)	舒张压 (mmHg)
稳定斑块组	50	24	26	59.72±7.64	64.76±7.59	32	26	13.96±3.16	160.10±14.39	98.84±12.91
不稳定斑块组	52	26	26	59.71±7.61	67.60±6.59	39	32	15.87±4.71	163.85±22.78	99.10±9.78
t/χ²值		0.041		0.006	-2.017	1.458	0.945	-2.408	-0.997	-0.113
P值		0.840		0.996	0.046	0.227	0.331	0.018	0.322	0.911

组别	例数	FPG(mmol/L)	TC(mmol/L)	TG(mmol/L)	HDL-C(mmol/L)	LDL-C(mmol/L)	Lp-PLA2(U/L)
稳定斑块组	50	4.47±0.43	4.03±0.96	1.30±0.40	1.15±0.25	2.50±0.76	464.70±64.76
不稳定斑块组	52	4.66±0.60	4.45±0.89	1.49±0.65	1.13±0.27	2.74±0.82	592.31±60.42
t值		-1.854	-2.251	-1.785	0.421	-1.572	-10.295
P值		0.067	0.027	0.078	0.675	0.119	0.000

组别	例数	FPG(mmol/L)	TC(mmol/L)	TG(mmol/L)	HDL-C(mmol/L)	LDL-C(mmol/L)	Lp-PLA2(U/L)
稳定斑块组	50	4.47±0.43	4.03±0.96	1.30±0.40	1.15±0.25	2.50±0.76	464.70±64.76
不稳定斑块组	52	4.66±0.60	4.45±0.89	1.49±0.65	1.13±0.27	2.74±0.82	592.31±60.42
t值		-1.854	-2.251	-1.785	0.421	-1.572	-10.295
P值		0.067	0.027	0.078	0.675	0.119	0.000

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
变量	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
Lp-PLA2	0.036	0.008	20.970	0.000	1.037	1.021	1.053
常量	-25.877	5.831	19.693	0.000	0.000