Predictive value of plasma oxidized low-density lipoprotein and hyperintense signals of magnetic resonance vessel wall imaging for plaque stability in acute cerebral infarction

doi:10.11958/20253394

Abstract

Abstract:

Objective To explore the predictive value of plasma oxidized low-density lipoprotein (ox-LDL) combined with high-resolution vascular wall imaging (HRMR-VWI) hyperintensity features for the stability of atherosclerotic plaques in patients with cerebral infarction. Methods A total of 147 patients with cerebral infarction were selected and divided into the stable group (n=61) and the unstable group (n=86) based on plaque stability. Baseline data were collected from both groups, and plaque characteristic indicators were obtained through HRMR-VWI examination. Pearson correlation analysis was used to explore the relationship between ox-LDL and HRMR-VWI indicators. ROC curve analysis was conducted to evaluate the predictive efficacy of individual and combined indicators for plaque instability. Multivariate Logistic regression analysis was performed to identify the influencing factors of plaque instability. Results Compared with the stable group, there were significantly increased levels of triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FPG), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), lipoprotein related phospholipase A2 (LP-PLA2), C-reactive protein (CRP), cystatin C (CysC), homocysteine (HCY) and ox-LDL in the unstable group (P<0.05). The plaque burden, incidence of intraplaque hemorrhage, incidence of fibrous cap damage and incidence of large lipid necrosis core were also significantly increased (P<0.05). Spearman correlation analysis showed that ox-LDL was positively correlated with plaque burden (r_s=0.174), plaque bleeding (r_s=0.241) and fibrous cap damage (r_s=0.352) (P<0.05). ROC curve analysis revealed that the AUCs for ox-LDL, plaque burden, intraplaque hemorrhage, fibrous cap rupture and combined prediction were 0.802 (0.728-0.863), 0.798 (0.723-0.859), 0.754 (0.676-0.821), 0.774 (0.698-0.839) and 0.957 (0.910-0.983), respectively, with combined prediction demonstrating the highest efficacy. Multivariate Logistic regression analysis indicated that ox-LDL (OR=1.137,95%CI: 1.070-1.208), plaque burden (OR=1.292, 95%CI: 1.151-1.450), intraplaque hemorrhage (OR=2.843, 95%CI: 2.239-3.611) and fibrous cap rupture (OR=3.200, 95%CI: 2.494-4.104) were risk factors for plaque in stability in patients with cerebral infarction (P<0.05). Conclusion The levels of plasma ox-LDL and related indicators of HRMR-VWI (plaque burden, intraplaque hemorrhage and fibrous cap damage) are closely related to plaque stability in patients with cerebral infarction. Combined detection can significantly improve the predictive efficacy of plaque instability.

Key words: brain infarction, oxidized low-density lipoprotein, magnetic resonance vascular wall imaging, plaque stability, predictive value

CLC Number:

R743.3，R445

Figures/Tables 5

References 22

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组别		n	年龄/岁		性别（男/女）		BMI/（kg/m2）		吸烟史		饮酒史		高血压史		糖尿病史			TC/（mmol/L）		TG/（mmol/L）
稳定组		61	62.35±8.69		36/25		24.26±2.68		27（44.26）		22（36.07）		31（50.82）		21（34.43）			4.85±0.93		1.86±0.75
不稳定组		86	64.84±9.14		55/31		23.98±2.54		36（41.86）		39（45.35）		41（47.67）		34（39.53）			5.16±1.17		2.35±0.92
t或χ2			1.608		0.369		0.638		0.084		1.267		0.141		0.398			1.787		3.549^＊＊
组别	HDL-C/（mmol/L）			LDL-C/（mmol/L）		FPG/（mmol/L）		HbA1c/%		SBP/（mmHg）		DBP/（mmHg）		LP-PLA2/（U/L）		CRP/（mg/L）	CysC/（mg/L）		HCY/（μmol/L）		ox-LDL/（U/L）
稳定组	0.97±0.26			2.94±0.63		5.63±1.03		5.84±0.83		135.12±12.34		82.35±8.69		206.33±22.01		4.26±1.06	0.92±0.15		12.35±3.15		65.89±10.63
不稳定组	1.05±0.24			3.19±0.75		6.25±1.16		6.75±1.01		142.62±13.48		93.65±9.17		241.35±29.25		6.74±1.59	1.15±0.23		16.62±3.84		82.36±12.87
t或χ2	1.897			2.189^＊		3.411^＊＊		5.980^＊＊		3.493^＊＊		7.591^＊＊		8.280^＊＊		11.341^＊＊	7.332^＊＊		7.387^＊＊		8.473^＊＊

组别		n	年龄/岁		性别（男/女）		BMI/（kg/m2）		吸烟史		饮酒史		高血压史		糖尿病史			TC/（mmol/L）		TG/（mmol/L）
稳定组		61	62.35±8.69		36/25		24.26±2.68		27（44.26）		22（36.07）		31（50.82）		21（34.43）			4.85±0.93		1.86±0.75
不稳定组		86	64.84±9.14		55/31		23.98±2.54		36（41.86）		39（45.35）		41（47.67）		34（39.53）			5.16±1.17		2.35±0.92
t或χ2			1.608		0.369		0.638		0.084		1.267		0.141		0.398			1.787		3.549^＊＊
组别	HDL-C/（mmol/L）			LDL-C/（mmol/L）		FPG/（mmol/L）		HbA1c/%		SBP/（mmHg）		DBP/（mmHg）		LP-PLA2/（U/L）		CRP/（mg/L）	CysC/（mg/L）		HCY/（μmol/L）		ox-LDL/（U/L）
稳定组	0.97±0.26			2.94±0.63		5.63±1.03		5.84±0.83		135.12±12.34		82.35±8.69		206.33±22.01		4.26±1.06	0.92±0.15		12.35±3.15		65.89±10.63
不稳定组	1.05±0.24			3.19±0.75		6.25±1.16		6.75±1.01		142.62±13.48		93.65±9.17		241.35±29.25		6.74±1.59	1.15±0.23		16.62±3.84		82.36±12.87
t或χ2	1.897			2.189^＊		3.411^＊＊		5.980^＊＊		3.493^＊＊		7.591^＊＊		8.280^＊＊		11.341^＊＊	7.332^＊＊		7.387^＊＊		8.473^＊＊

组别		n	斑块负荷		血管壁最大厚度/mm			斑块内出血
稳定组		61	0.62±0.05		1.72±0.31			18（29.51）
不稳定组		86	0.68±0.07		1.83±0.46			50（58.14）
t或χ2			5.353^＊＊		1.732			11.768^＊＊
组别	血管狭窄程度/%			纤维帽破损		RI	大脂质坏死核心
稳定组	25.76±6.41			12（19.67）		0.98±0.12	25（40.98）
不稳定组	28.07±8.52			26（30.23）		1.02±0.18	54（62.79）
t或χ2	1.875			4.624^＊		1.616	6.827^＊＊

组别		n	斑块负荷		血管壁最大厚度/mm			斑块内出血
稳定组		61	0.62±0.05		1.72±0.31			18（29.51）
不稳定组		86	0.68±0.07		1.83±0.46			50（58.14）
t或χ2			5.353^＊＊		1.732			11.768^＊＊
组别	血管狭窄程度/%			纤维帽破损		RI	大脂质坏死核心
稳定组	25.76±6.41			12（19.67）		0.98±0.12	25（40.98）
不稳定组	28.07±8.52			26（30.23）		1.02±0.18	54（62.79）
t或χ2	1.875			4.624^＊		1.616	6.827^＊＊

指标	截断值	AUC	95%CI	约登指数	特异度/%	敏感度/%	Z^＃
ox-LDL	79.77 U/L	0.802	0.728~0.863	0.474	95.1	52.3	4.710^＊＊
斑块负荷	0.65	0.798	0.723~0.859	0.503	77.1	73.3	4.852^＊＊
斑块内出血	-	0.754	0.676~0.821	0.507	70.5	80.2	5.917^＊＊
纤维帽破损	-	0.774	0.698~0.839	0.548	80.3	74.4	5.869^＊＊
联合预测	-	0.957	0.910~0.983	0.792	88.5	90.7	-