急性缺血性脑卒中患者血清指标与病情和预后的关系

doi:10.11958/20231051

天津医药 ›› 2024, Vol. 52 ›› Issue (2): 172-176.doi: 10.11958/20231051

急性缺血性脑卒中患者血清指标与病情和预后的关系

丁波¹(), 龚洁芹¹^,^△(), 沈李奎²

1.上海交通大学医学院苏州九龙医院神经内科（邮编215028），2. 神经外科

收稿日期:2023-07-16 修回日期:2023-09-14 出版日期:2024-02-15 发布日期:2024-01-26
通讯作者: ^△ E-mail:yu0xiao2xiao@163.com
作者简介:丁波（1985），男，副主任医师，主要从事脑血管病研究。E-mail:dingbo85218@163.com
基金资助:
江苏省医院协会医院管理创新研究课题(JSYGY-3-2021-455)

Relationship between serum indexes, pathogenetic condition and prognosis in patients with acute ischemic stroke

DING Bo¹(), GONG Jieqin¹^,^△(), SHEN Likui²

1. Department of Neurology, 2. Department of Neurosurgery, Suzhou Kowloon Hospital Shanghai Jiao Tong University School of Medicine, Suzhou 215028, China

Received:2023-07-16 Revised:2023-09-14 Published:2024-02-15 Online:2024-01-26
Contact: ^△ E-mail: yu0xiao2xiao@163.com

丁波, 龚洁芹, 沈李奎. 急性缺血性脑卒中患者血清指标与病情和预后的关系[J]. 天津医药, 2024, 52(2): 172-176.

DING Bo, GONG Jieqin, SHEN Likui. Relationship between serum indexes, pathogenetic condition and prognosis in patients with acute ischemic stroke[J]. Tianjin Medical Journal, 2024, 52(2): 172-176.

摘要/Abstract

摘要：

目的探讨急性缺血性脑卒中（AIS）患者血清脂蛋白相关磷脂酶A2（Lp-PLA2）、低密度脂蛋白（LDL）、β淀粉样蛋白1-42（Aβ_1-42）、可溶性细胞间黏附分子1（sICAM-1）水平与美国国立卫生研究院卒中量表（NIHSS）评分和预后的关系。方法选取AIS静脉溶栓患者（溶栓组）106例、未溶栓患者（未溶栓组）30例和健康体检者（对照组）95例。将溶栓患者根据溶栓后是否静脉再通分为再通组41例和未通组65例，依据NIHSS评分分为轻度组45例、中度组36例、重度组25例，通过改良Rankin量表（mRS）评分分为预后良好组65例和预后不良组41例。对比不同分组情况下4种血清指标水平，并分析其与NIHSS评分及预后的关系。结果 106例溶栓患者静脉再通率为38.68%（41/106）；再通组血清Lp-PLA2、LDL、Aβ_1-42、sICAM-1水平均低于未通组（P<0.05）；对照组、溶栓组、未溶栓组血清Lp-PLA2、LDL、Aβ_1-42、sICAM-1水平均依次升高（P<0.05）；4种血清指标随溶栓患者病情加重而上升，且与NIHSS评分呈正相关（P<0.05）；高水平血清Lp-PLA2、LDL、Aβ_1-42、sICAM-1是溶栓患者预后不良的危险因素，其联合预测溶栓患者预后不良的曲线下面积（AUC）、特异度均高于单一指标检测（P<0.05）。结论血清Lp-PLA2、LDL、Aβ_1-42、sICAM-1水平在AIS患者中呈高表达，可作为病情监测及预后评估的重要参考指标。

Abstract:

Objective To discuss the relationship between serum lipoprotein-associated phospholipase A2 (Lp-PLA2), low-density lipoprotein (LDL), amyloid beta 1-42 (Aβ_1-42) and soluble intercellular adhesion molecule-1 (sICAM-1) levels, the National Institutes of Health Stroke Scale (NIHSS) score and prognosis in patients with acute ischemic stroke (AIS). Methods A total of 106 patients with AIS who underwent intravenous thrombolysis (the thrombolysis group), 30 AIS patients without thrombolysis (the non-thrombolysis group) and 95 healthy individuals (the control group) were included in the study. The thrombolysis group was divided into the recanalization group (n=41) and the non-recanalization group (n=65) according to whether the vein was recanalized after thrombolysis. Patients were divided into the mild group (n=45), the moderate group (n=36) and the severe group (n=25) based on the NIHSS score. They were divided into the good prognosis group (n=65) and the poor prognosis group (n=41) based on the modified Rankin Scale (mRS) score. Serum levels of four indexes in different groups were compared. Their relationship with the NIHSS score and the prognosis was analyzed. Results The vein recanalization rate in 106 patients with thrombolysis was 38.68% (41/106). Serum Lp-PLA2, LDL, Aβ_1-42 and sICAM-1 levels were lower in the recanalization group than those in the non-canalization group (P<0.05). Serum Lp-PLA2, LDL, Aβ_1-42 and sICAM-1 levels increased successively in the control group, the thrombolysis group and the non-thrombolysis group (P<0.05). The 4 serum indexes increased with the aggravation of disease condition, and were positively correlated with NIHSS score (P<0.05). High serum levels of Lp-PLA2, LDL, Aβ_1-42 and sICAM-1 were risk factors for poor prognosis of patients with thrombolysis (P<0.05). The area under the curve (AUC) and specificity of the combination of 4 serum indexes for predicting poor prognosis of patients with thrombolysis were higher than those of prediction with single index (P<0.05). Conclusion The expression levels of serum Lp-PLA2, LDL, Aβ_1-42 and sICAM-1 in patients with AIS are high. They can be used as important reference indexes for disease condition monitoring and prognosis evaluation.

Key words: ischemic stroke, lipoprotein-associated phospholipase a2, low density lipoprotein, amyloid beta 1-42, soluble intercellular adhesion molecule 1, prognosis

中图分类号:

R743.3

图/表 7

参考文献 20

[1]	李文杰, 康小荣, 孙元培. 银杏酮酯滴丸治疗缺血性脑白质病的疗效及部分作用机制研究[J]. 中药材, 2021, 44(2):465-469.
	LI W J, KANG X R, SUN Y P. Efficacy and partial mechanism of Gingko Ketone Ester Dropping Pills in the treatment of ischemic leukoencephalopathy[J]. J Chin Med Mat, 2021, 44(2):465-469. doi:10.13863/j.issn1001-4454.2021.02.040.
[2]	WASSÉLIUS J, ARNBERG F, VON EULER M, et al. Endovascular thrombectomy for acute ischemic stroke[J]. J Intern Med, 2022, 291(3):303-316. doi:10.1111/joim.13425.
[3]	乌云嘎, 魏君, 常宏, 等. LP-PLA2:预测心血管疾病的新兴标志物[J]. 中国实验诊断学, 2022, 26(9):1417-1419.
	WU Y G, WEI J, CHANG H, et al. LP-PLA2:An emerging biomarker for predicting cardiovascular disease[J]. Chin J Lab Diag, 2022, 26(9):1417-1419. doi:10.3969/j.issn.1007-4287.2022.09.041.
[4]	HARTLEY A, HASKARD D, KHAMIS R. Oxidized LDL and anti-oxidized LDL antibodies in atherosclerosis-Novel insights and future directions in diagnosis and therapy[J]. Trends Cardiovasc Med, 2019, 29(1):22-26. doi:10.1016/j.tcm.2018.05.010.
[5]	SATO Y, TAKIGUCHI M, TAMANO H, et al. Extracellular Zn²⁺-Dependent Amyloid-β_1-42 neurotoxicity in Alzheimer's disease pathogenesis[J]. Biol Trace Elem Res, 2021, 199(1):53-61. doi:10.1007/s12011-020-02131-w.
[6]	孙娜, 马先军, 肖辉, 等. 血清sICAM-1、VEGF在缺血性脑卒中致血管性痴呆患者中的表达及临床意义[J]. 中国现代医学杂志, 2022, 32(13):15-20.
	SUN N, MA X J, XIAO H, et al. Expression and clinical significance of serum sICAM-1 and VEGF in patients with vascular dementia caused by ischemic stroke[J]. Chin J Modern Med, 2022, 32(13):15-20. doi:10.3969/j.issn.1005-8982.2022.13.003.
[7]	袁莉, 张建兴, 王素洁, 等. 入院时美国国立卫生研究院卒中量表联合血清超敏C-反应蛋白对缺血性卒中预后的预测价值[J]. 中国现代神经疾病杂志, 2022, 22(7):615-620.
	YUAN L, ZHANG J X, WANG S J, et al. Predictive value of National Institutes of Health Stroke Scale combined with serum high-sensitivity C-reactive protein at admission to ischemic stroke[J]. Chin J Contemp Neurol Neurosurg, 2022, 22(7):615-620. doi:10.3969/j.issn.1672-6731.2022.07.011.
[8]	张磊, 刘建民. 改良Rankin量表[J]. 中华神经外科杂志, 2012, 28(5):512.
	ZHANG L, LIU J M. Modified Rankin scale[J]. Chin J Neurosurg, 2012, 28(5):512.
[9]	JOLUGBO P, ARIËNS R A S. Thrombus composition and efficacy of thrombolysis and thrombectomy in acute ischemic stroke[J]. Stroke, 2021, 52(3):1131-1142. doi:10.1161/STROKEAHA.120.032810.
[10]	王景, 董坤, 黄优, 等. 急性缺血性脑卒中患者血清miR-433-5p表达水平及其与Hcy及MMP-9的相关性研究[J]. 现代检验医学杂志, 2022, 37(3):87-90.
	WANG J, DONG K, HUANG Y, et al. Expression of serum miR-433-5p and its correlation with Hcy and MMP-9 in patients with acute ischemic stroke[J]. J Mod Lab Med, 2022, 37(3):87-90. doi:10.3969/j.issn.1671-7414.2022.03.018.
[11]	韩媛, 王爽, 黄超, 等. 急性缺血性脑卒中患者血清Lp-PLA2与HCY、hsCRP及生化指标的相关性分析[J]. 中华急诊医学杂志, 2019, 28(8):1026-1028.
	HAN Y, WANG S, HUANG C, et al. Correlation between serum Lp-PLA2 and HCY,hsCRP,biochemical indexes in patients with acute ischemic stroke[J]. Chin J Emerg Med, 2019, 28(8):1026-1028. doi:10.3760/cma.j.issn.1671-0282.2019.08.021.
[12]	杨玉梅, 金晓烨, 贺丽. 脑梗死病人颈动脉粥样硬化斑块性质及神经功能损伤程度与血浆Lp-PLA2水平的关系[J]. 中西医结合心脑血管病杂志, 2021, 19(17):2994-2998.
	YANG Y M, JIN X Y, HE L. Correlation between the degree of carotid atherosclerosis,plaque properties,nerve function and the level of plasma Lp-PLA2 in patients with cerebral infarction[J]. Chin J Integr Med Cardio-Cerebrovasc Dis, 2021, 19(17):2994-2998. doi:10.12102/j.issn.1672-1349.2021.17.026.
[13]	贾正常, 赵静, 乔晓, 等. Lp-PLA_2联合LDL-C预测急性缺血性脑卒中发生及复发的预警意义[J]. 中西医结合心脑血管病杂志, 2020, 18(23):4069-4073.
	JIA Z C, ZHAO J, QIAO X, et al. Significance of Lp-PLA_2 combined with LDL-C in predicting the occurrence and recurrence of acute ischemic stroke[J]. Chin J Integr Med Cardio-Cerebrovasc Dis, 2020, 18(23):4069-4073. doi:10.12102/j.issn.1672-1349.2020.23.039.
[14]	AL-EDRESI S, ALSALAHAT I, FREEMAN S, et al. Resveratrol-mediated cleavage of amyloid β1-42 peptide:potential relevance to Alzheimer's disease[J]. Neurobiol Aging, 2020, 94:24-33. doi:10.1016/j.neurobiolaging.2020.04.012.
[15]	WITSCH J, ROH D, OH S, et al. Association between soluble intercellular adhesion molecule-1 and intracerebral hemorrhage outcomes in the FAST trial[J]. Stroke, 2023, 54(7):1726-1734. doi:10.1161/STROKEAHA.123.042466.
[16]	李一璐, 周亚军, 任晨曦, 等. 急性缺血性脑卒中患者血清RBP4,Lp-PLA2及MCP-1水平表达及其与患者病情及预后的关系研究[J]. 现代生物医学进展, 2022, 22(11):2086-2090,2027.
	LI Y L, ZHOU Y J, REN C X, et al. Study on the expression of serum RBP4,Lp-PLA2 and MCP-1 in patients with acute ischemic stroke and their relationship with patient condition and prognosis[J]. Prog Mod Biomed, 2022, 22(11):2086-2090,2027. doi:10.13241/j.cnki.pmb.2022.11.016.
[17]	SOFOGIANNI A, ALKAGIET S, TZIOMALOS K. Lipoprotein-associated phospholipase A2 and coronary heart disease[J]. Curr Pharm Des, 2018, 24(3):291-296. doi:10.2174/1381612824666180111110550.
[18]	李添翼, 翟蕴新, 郑瑞雪, 等. ox-LDL,ox-LDL/HDL,ox-LDL/LDL与不同亚型急性脑梗死病人不良预后的相关性[J]. 中西医结合心脑血管病杂志, 2020, 18(24):4273-4275.
	LI T Y, ZHAI Y X, ZHENG R X, et al. Correlation between ox-LDL,ox-LDL/HDL,ox-LDL/LDL and poor prognosis in patients with different subtypes of acute cerebral infarction[J]. Chin J Integr Med Cardio-Cerebrovasc Dis, 2020, 18(24):4273-4275. doi:10.12102/j.issn.1672-1349.2020.24.043.
[19]	汪东良, 王锦华, 韩威威, 等. 血清学标志物Aβ1-42、sICAM-1、VILIP-1对脑梗死后血管性痴呆的预测价值[J]. 中华全科医学, 2019, 17(2):225-229.
	WANG D L, WANG J H, HAN W W, et al. The predictive value of serological markers Aβ1-42,sICAM-1 and VILIP-1 for vascular dementia after cerebral infarction[J]. Chin J Gen Pract, 2019, 17(2):225-229. doi:10.16766/j.cnki.issn.1674-4152.000646.
[20]	刘书芳, 汪琳, 彭聪, 等. 急性脑梗死患者血清sICAM-1、VS-2、D-二聚体水平的变化及意义[J]. 中国老年学杂志, 2018, 38(6):1319-1321.
	LIU S F, WANG L, PENG C, et al. Changes and significance of serum sICAM-1,VS-2 and D-dimer levels in patients with acute cerebral infarction[J]. Chin J Gerontol, 2018, 38(6):1319-1321. doi:10.3969/j.issn.1005-9202.2018.06.017.

组别	n	Lp-PLA2/ （mg/L）	LDL/ （mmol/L）	Aβ_1-42/ （ng/L）	sICAM-1/ （ng/L）
未通组	65	285.27±31.66	4.51±0.90	68.00±9.94	391.16±59.09
再通组	41	209.57±20.27	3.96±0.86	61.28±7.08	345.97±43.54
t		15.009^＊＊	3.148^＊＊	4.058^＊＊	4.520^＊＊

组别	n	Lp-PLA2/ （mg/L）	LDL/ （mmol/L）	Aβ_1-42/ （ng/L）	sICAM-1/ （ng/L）
未通组	65	285.27±31.66	4.51±0.90	68.00±9.94	391.16±59.09
再通组	41	209.57±20.27	3.96±0.86	61.28±7.08	345.97±43.54
t		15.009^＊＊	3.148^＊＊	4.058^＊＊	4.520^＊＊

组别	n	Lp-PLA2/（mg/L）	LDL/（mmol/L）	Aβ_1-42/（ng/L）	sICAM-1/（ng/L）
对照组	95	147.98±15.15	3.02±0.38	52.69±5.20	304.02±32.73
溶栓组	106	255.99±46.26^a	4.30±0.92^a	65.40±9.49^a	373.68±57.79^a
未溶栓组	30	268.02±35.74^ab	5.22±0.48^ab	70.02±6.44^ab	395.99±60.61^ab
F		276.988^＊＊	147.769^＊＊	95.353^＊＊	65.947^＊＊

组别	n	Lp-PLA2/（mg/L）	LDL/（mmol/L）	Aβ_1-42/（ng/L）	sICAM-1/（ng/L）
对照组	95	147.98±15.15	3.02±0.38	52.69±5.20	304.02±32.73
溶栓组	106	255.99±46.26^a	4.30±0.92^a	65.40±9.49^a	373.68±57.79^a
未溶栓组	30	268.02±35.74^ab	5.22±0.48^ab	70.02±6.44^ab	395.99±60.61^ab
F		276.988^＊＊	147.769^＊＊	95.353^＊＊	65.947^＊＊

组别	n	Lp-PLA2/（mg/L）	LDL/（mmol/L）	Aβ_1-42/（ng/L）	sICAM-1/（ng/L）
轻度组	45	239.11±39.41	3.80±0.74	61.26±7.00	346.24±41.89
中度组	36	245.85±43.76^a	4.32±0.81^a	63.84±7.36^a	369.12±55.73^a
重度组	25	300.97±30.39^ab	5.16±0.70^ab	75.11±9.55^ab	429.64±46.46^ab
F		21.939^＊＊	25.843^＊＊	26.517^＊＊	24.462^＊＊

急性缺血性脑卒中患者血清指标与病情和预后的关系

Relationship between serum indexes, pathogenetic condition and prognosis in patients with acute ischemic stroke

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组别	n	Lp-PLA2/（mg/L）	LDL/（mmol/L）	Aβ_1-42/（ng/L）	sICAM-1/（ng/L）
预后良好组	65	232.43±34.03	3.83±0.69	60.64±6.12	343.51±39.20
预后不良组	41	293.33±37.85	5.05±0.72	72.95±9.02	421.50±49.85
t		8.591^＊＊	8.725^＊＊	7.691^＊＊	8.497^＊＊

变量	β	SE	Wald χ²	P	OR（95% CI）
Lp-PLA2	0.050	0.023	4.851	0.028	1.051（1.006~1.099）
LDL	4.528	1.680	7.265	0.007	92.598（3.440~2 492.642）
Aβ_1-42	0.357	0.145	6.049	0.014	1.430（1.075~1.901）
sICAM-1	0.030	0.015	4.096	0.043	1.031（1.001~1.062）
常数项	-68.347	21.580	10.031	0.002

指标	AUC（95% CI）	临界值	敏感度/%	特异度/%
Lp-PLA2	0.884（0.816~0.952）	269.59 mg/L	85.40	86.20
LDL	0.893（0.836~0.951）	4.07 mmol/L	100.00	66.20
Aβ_1-42	0.877（0.802~0.953）	65.03 ng/L	87.80	83.10
sICAM-1	0.882（0.816~0.948）	378.77 ng/L	80.50	83.10
指标联合	0.940（0.885~0.995）		92.70	95.40

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