脂蛋白相关磷脂酶A2水平、微栓子信号与大动脉粥样硬化型急性脑梗死患者短期预后的关系

摘要

Objective To investigate the relationship between Lipoprotein-associated phospholipase A 2/microembol-ic signals ( Lp-PLA2/MES) and short outcome among patients with acute ischemic stroke due to large-artery atherosclero-sis.Methods 238 patients with acute ischemic stroke of large-artery atherosclerosis type within 72 h after onset were in-cluded.Data on clinical data and laboratory findings of the patients were collected .Recovery was assessed by modified Rankin Scale ( mRS) at 14 days follow-up.The clinical data ,Lp-PLA2 and MES were compared between good prognosis and poor outcome in patients .Subjects of this study were divided into four groups:normal Lp-PLA2 with negative MES ( NL/NM);normal Lp-PLA2 with positive MES (NL/IM);high Lp-PLA2 with negative MES (IL/NM) and high Lp-PLA2 with positive MES ( IL/IM) .Non-conditional logistic regression analysis was conducted to evaluate the association between Lp -PLA2/MES and the short outcome of acute ischemic stroke .Results Lp-PLA2 and the ratio of positive MES in patients with poor outcome were both higher than those with good prognosis (all P<0.05).After multivariate adjustment,when compared to NL/NM group,the ORs (95%CI) of NL/IM,IL/NM and IL/IM group were 0.719 (0.112~4.627),4.687 (1.506~14.58) and 14.868 (3.373~65.538),respectively.Conclusion Lp-PLA2 at admission was an independent risk factor of poor short outcome among patients with acute ischemic stroke .Positive MES amplified the effect of Lp-PLA2 in the process of poor short outcome .Lp-PLA2/MES was valuable in predicting the incidence of poor short outcome in acute is -chemic stroke patients of large-artery atherosclerosis type .%目的 研究大动脉粥样硬化型急性脑梗死患者住院时的脂蛋白相关磷脂酶A2水平、微栓子信号对其短期预后的影响.方法 募集起病72 h内的大动脉粥样硬化型急性脑梗死患者238例,收集其入院时的临床资料及实验室资料等.根据改良Rankin量表评分将患者分为预后良好组(0~2分)和预后不良组(>2分).将研究对象分为4组:脂蛋白相关磷脂酶A2正常、微栓子信号阴性组(NL/NM);脂蛋白相关磷脂酶A2正常、微栓子信号阳性组(NL/IM);脂蛋白相关磷脂酶A2升高、微栓子信号阴性组(IL/NM);脂蛋白相关磷脂酶A2升高、微栓子信号阳性组(IL/IM).采用非条件Logistic回归分析脂蛋白相关磷脂酶A2水平、微栓子信号与急性脑梗死短期预后的关系.结果 急性脑梗死患者预后不良组入院时的脂蛋白相关磷脂酶A2水平、微栓子信号阳性率均高于预后良好组(均P<0.05).经多因素调整后,与NL/NM相比,NL/IM、IL/NM和IL/IM组发生预后不良的OR值(95%CI)分别为0.719(0.112~4.627)、4.687(1.506~14.588)和14.868(3.373~65.538).结论 急性脑梗死患者入院时脂蛋白相关磷脂酶A2水平是其短期预后不良的独立危险因素,微栓子信号阳性显著放大了高水平脂蛋白相关磷脂酶A2对发生短期预后不良的作用,脂蛋白相关磷脂酶A2/微栓子信号是大动脉粥样硬化型急性脑梗死短期预后不良的预测指标.