血漿Lp-PLA2對急性缺血性腦卒中診斷的臨床研究
發(fā)布時(shí)間：2019-07-06 08:46
【摘要】：目的:缺血性腦卒中的診斷主要依靠患者的癥狀/體征以及CT/MRI等影像學(xué)檢查,目前臨床仍缺乏快速、敏感以及特異性的血液生化學(xué)指標(biāo)。最新研究表明炎性反應(yīng)是導(dǎo)致動脈粥樣硬化和缺血性卒中的重要機(jī)制之一,人血漿脂蛋白相關(guān)磷脂酶A2(Lp-PLA2)由單核巨噬細(xì)胞產(chǎn)生,參與氧化低密度脂蛋白的代謝,促進(jìn)血管特異性炎癥和粥樣硬化的進(jìn)程,有可能是提示缺血性腦卒中的發(fā)生及動脈粥樣硬化型腦卒中的重要依據(jù)。本研究應(yīng)用免疫增強(qiáng)比濁法檢測急性缺血性腦卒中患者血漿Lp-PLA2水平,并與健康體檢者對比,以探討血漿Lp-PLA2水平是否具有提示急性缺血性腦卒中的診斷及分型的價(jià)值,為急性缺血性卒中的診斷提供新的思路,同時(shí)為進(jìn)一步個(gè)體化治療提供理論依據(jù)。方法:1材料1.1研究對象選取河北醫(yī)科大學(xué)第二醫(yī)院神經(jīng)內(nèi)科2014年12月至2015年12月住院的急性缺血性腦卒中病人90例為觀察組,其中男性74例,女性16例,年齡45~80歲,平均年齡58.58±8.46歲。就診時(shí)間為發(fā)病后4小時(shí)~3天。首次發(fā)病者66例,復(fù)發(fā)者24例。另一組為我院體檢中心健康體檢者90例為對照組,其中男性74例,女性16例,年齡45~80歲,平均年齡59.30±8.43歲。1.1.1入排標(biāo)準(zhǔn)入組標(biāo)準(zhǔn):1)觀察組的患者均符合1995年全國第4屆腦血管病學(xué)術(shù)會議所制定的《各類腦血管疾病診斷要點(diǎn)》腦梗死診斷標(biāo)準(zhǔn),均行顱腦MRI+DWI+MRA檢查并證實(shí);2)年齡45~80歲;3)發(fā)病時(shí)間3天;4)簽署知情同意書。排除標(biāo)準(zhǔn):1)年齡45歲或80歲:2)發(fā)病時(shí)間3天;3)無法行頭顱磁共振檢查者;4)腦出血、蛛網(wǎng)膜下腔出血、顱內(nèi)靜脈(竇)血栓形成等其它血管疾病者;5)并發(fā)急性冠脈綜合征患者;6)并發(fā)嚴(yán)重的心、肝、肺、腎功能損害;7)妊娠、創(chuàng)傷、感染、腫瘤或免疫性疾病者;8)未簽署知情同意書者。1.1.2觀察組分型根據(jù)CISS分型[11]對觀察組進(jìn)一步分型:1)大動脈粥樣硬化型(LAA),分為主動脈弓粥樣硬化及顱內(nèi)外大動脈粥樣硬化,共56例;2)穿支動脈疾病(PAD),共23例;3)心源性卒中(CS),共4例;4)其他病因(OE),共0例;5)不確定病因(UE),共7例。2實(shí)驗(yàn)方法2.1標(biāo)本采集所有病例入院后均采取晨起空腹靜脈血3ml,并經(jīng)乙二胺四乙酸(EDTA)抗凝,5小時(shí)內(nèi)完成免疫增強(qiáng)比濁法測定血漿Lp-PLA2水平。2.2血漿Lp-PLA2及其他生化指標(biāo)測定采用南京諾爾曼生物技術(shù)有限公司生產(chǎn)的NORMAN系列散射比濁分析儀和脂蛋白磷脂酶A2測定試劑盒,采用免疫增強(qiáng)比濁法檢測,操作流程按試劑盒說明書進(jìn)行。其他生化指標(biāo)應(yīng)用美國全自動生化分析儀測定Chol、TG、LDL-C、HDL-C、Hcy、hs-CRP水平。3統(tǒng)計(jì)學(xué)方法采用SPSS 21.0統(tǒng)計(jì)軟件對實(shí)驗(yàn)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,符合正態(tài)分布的計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差表示,非正態(tài)分布的計(jì)量資料則用中位數(shù)(四分位間距)表示,正態(tài)分布的兩組組間比較用t檢驗(yàn),非正態(tài)分布者用秩和檢驗(yàn)。兩組間單向有序等級資料比較用Kruskal-Wallis檢驗(yàn),等級資料的相關(guān)性分析用Spearman秩相關(guān)系數(shù)描述相關(guān)性。兩組間計(jì)數(shù)資料的比較用χ2檢驗(yàn),P0.05認(rèn)為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1觀察組和對照組的年齡、性別構(gòu)成比、飲酒比例經(jīng)t檢驗(yàn)或χ2檢驗(yàn),差異無統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組和對照組的吸煙、高血壓、糖尿病比例經(jīng)χ2檢驗(yàn)均具有統(tǒng)計(jì)學(xué)差異(P0.05)。2觀察組和對照組血漿TG、LDL-C水平經(jīng)秩和檢驗(yàn)差異無統(tǒng)計(jì)學(xué)意義(P0.05)。對照組Chol和HDL-C水平比觀察組高,經(jīng)秩和檢驗(yàn)或t檢驗(yàn)均具有統(tǒng)計(jì)學(xué)差異(P0.05)。3觀察組與對照組血漿Lp-PLA2水平差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4男性與女性患者分別進(jìn)行觀察組與對照組Lp-PLA2水平比較(P0.05),無統(tǒng)計(jì)學(xué)差異。5首發(fā)型及復(fù)發(fā)型急性缺血性腦卒中患者與對照組血漿Lp-PLA2水平比較均無統(tǒng)計(jì)學(xué)差異(P0.05),首發(fā)型與復(fù)發(fā)型比較亦無統(tǒng)計(jì)學(xué)差異(P0.05)。6觀察組LAA型、PAD型、對照組組間比較(P0.05),差異無統(tǒng)計(jì)學(xué)意義。7血漿Lp-PLA2水平與hs-CRP呈顯著正相關(guān)(r=0.766,P=0.000),與發(fā)病時(shí)間、年齡、TG(r=-0.083,P=0.440)、Chol(r=0.125,P=0.244)、HDL(r=-0.196,P=0.066)、LDL(r=0.195,P=0.068)、Hcy(r=-0.036,P=0.738)無明顯相關(guān)性。結(jié)論:血漿Lp-PLA2水平對急性缺血性腦卒中的診斷及分型無提示意義;血漿Lp-PLA2水平與hs-CRP顯著正相關(guān)。Lp-PLA2與hs-CRP具有顯著相關(guān)性;Lp-PLA2水平與LDL-C、HDL-C的相關(guān)性可能尚需進(jìn)一步研究明確。
文內(nèi)圖片：
圖片說明：男性，57歲，，穿支動脈疾病型缺血性腦卒中
[Abstract]:Objective: The diagnosis of ischemic stroke mainly depends on the patient's symptoms/ signs and CT/ MRI. Recent studies have shown that inflammatory reaction is one of the most important mechanisms leading to atherosclerosis and ischemic stroke, and human plasma lipoprotein-related phospholipase A2 (Lp-PLA2) is produced by mononuclear macrophages, participates in the metabolism of oxidized low-density lipoprotein, promotes the process of blood vessel-specific inflammation and atherosclerosis, It may be an important basis to indicate the occurrence of ischemic stroke and the type of atherosclerosis. In this study, the plasma Lp-PLA2 level in patients with acute ischemic stroke was detected by immunopotentiation and nephelometry, and compared with the healthy physical examination, to study whether the plasma Lp-PLA2 level has the value of indicating the diagnosis and classification of acute ischemic stroke, and provides a new way for the diagnosis of acute ischemic stroke. And provides a theoretical basis for further individualized treatment. Methods: A total of 90 patients with acute ischemic stroke from December 2014 to December 2015 were selected from the Department of Neurology of the Second Hospital of Hebei Medical University from December 2014 to December 2015. The average age was 58.58 and 8.46 years. The treatment time was 4 hours to 3 days after the onset of the disease. There were 66 cases of the first onset and 24 cases of the recurrence. In the other group,90 patients with physical examination of the physical examination center of our hospital were in the control group, including 74 males and 16 females, aged 45 to 80 years, with an average age of 59.30 and 8.43 years. 1) The patients in the observation group met the criteria for the diagnosis of various types of cerebrovascular diseases, which were developed by the fourth session of the National Association of Cerebrovascular Diseases in 1995. The criteria for the diagnosis of cerebral infarction were examined and confirmed by the head MRI + DWI + MRA.2) The age was 45-80 years;3) the onset time was 3 days; and 4) the informed consent was signed. Exclusion criteria:1) age 45 years or 80 years:2) onset time 3 days;3) no head magnetic resonance examiners;4) cerebral hemorrhage, subarachnoid hemorrhage, intracranial venous (intracranial) thrombosis and other vascular diseases;5) patients with acute coronary syndrome; 6) concurrent severe heart, liver, lung, renal function impairment;7) pregnancy, trauma, infection, tumor or immune disease;8) without signing the informed consent form. 1.1.2 The observation component type is further classified according to the CISS type[11] to the observation group:1) the aorta atherosclerosis type (LAA), There were 56 cases (2) of the carotid artery disease (PAD),23 cases (3) of the cardiogenic stroke (CS),4 cases (4),4) other etiologies (OE),0 cases,5) the etiological factors (UE), A total of 7 cases were collected. All the cases were collected in the morning and the fasting venous blood was 3 ml. and the plasma Lp-PLA2 level, the plasma Lp-PLA2 level, the plasma Lp-PLA2 and other biochemical indexes were determined by using the EDTA (EDTA) anticoagulant, and the NORMAN series scattering turbidimetric analyzer and the lipoprotein phospholipase A2 measurement kit manufactured by the Nanjing Norman Biotech Co., Ltd. were used for measuring the plasma Lp-PLA2 and other biochemical indexes, And the operation flow is carried out according to the kit specification by adopting the immunopotentiation turbidimetry detection. The other biochemical indexes were used to determine the level of Chol, TG, LDL-C, HDL-C, Hcy, hs-CRP by the full-automatic biochemical analyzer in the United States. The median (quartile spacing) is used for the measurement data of the non-normal distribution, and t-test is used between the two groups of normal distribution, and the non-normal distribution is used for the rank sum test. The correlation between the two groups of one-way order data was compared with the Kruskal-Wallis test, and the correlation between the two groups was described by the Spearman rank correlation coefficient. The comparison of the count data between the two groups was tested by the 2-2 test, and the difference between the two groups was considered to be of statistical significance. Results: The age and sex ratio of the observation group and the control group were not statistically significant (P0.05). The levels of TG and LDL-C in the observation group and the control group were statistically different (P <0.05). The difference of TG and LDL-C in the observation group and the control group was not statistically significant (P0.05). The level of Chol and HDL-C in the control group was higher than that in the control group (P0.05). The difference of plasma Lp-PLA2 in the control group was not significant (P0.05). There was no statistical difference in the plasma Lp-PLA2 levels in the first and the relapse-type patients with acute ischemic stroke (P0.05). There was no significant correlation between plasma Lp-PLA2 level and hs-CRP (r = 0.766, P = 0.000), with the onset time, age, TG (r =-0.083, P = 0.440), Chol (r = 0.125, P = 0.244), HDL (r =-0.196, P = 0.066), LDL (r = 0.195, P = 0.068), Hcy (r =-0.036, P = 0.738). Conclusion: The plasma Lp-PLA2 level is not suggestive of the diagnosis and classification of acute ischemic stroke, and the plasma Lp-PLA2 level is positively correlated with hs-CRP. The relationship between Lp-PLA2 and hs-CRP has a significant correlation, and the correlation between Lp-PLA2 and LDL-C and HDL-C may need to be further studied.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R743.3
文內(nèi)圖片：
圖片說明：男性，57歲，，穿支動脈疾病型缺血性腦卒中
[Abstract]:Objective: The diagnosis of ischemic stroke mainly depends on the patient's symptoms/ signs and CT/ MRI. Recent studies have shown that inflammatory reaction is one of the most important mechanisms leading to atherosclerosis and ischemic stroke, and human plasma lipoprotein-related phospholipase A2 (Lp-PLA2) is produced by mononuclear macrophages, participates in the metabolism of oxidized low-density lipoprotein, promotes the process of blood vessel-specific inflammation and atherosclerosis, It may be an important basis to indicate the occurrence of ischemic stroke and the type of atherosclerosis. In this study, the plasma Lp-PLA2 level in patients with acute ischemic stroke was detected by immunopotentiation and nephelometry, and compared with the healthy physical examination, to study whether the plasma Lp-PLA2 level has the value of indicating the diagnosis and classification of acute ischemic stroke, and provides a new way for the diagnosis of acute ischemic stroke. And provides a theoretical basis for further individualized treatment. Methods: A total of 90 patients with acute ischemic stroke from December 2014 to December 2015 were selected from the Department of Neurology of the Second Hospital of Hebei Medical University from December 2014 to December 2015. The average age was 58.58 and 8.46 years. The treatment time was 4 hours to 3 days after the onset of the disease. There were 66 cases of the first onset and 24 cases of the recurrence. In the other group,90 patients with physical examination of the physical examination center of our hospital were in the control group, including 74 males and 16 females, aged 45 to 80 years, with an average age of 59.30 and 8.43 years. 1) The patients in the observation group met the criteria for the diagnosis of various types of cerebrovascular diseases, which were developed by the fourth session of the National Association of Cerebrovascular Diseases in 1995. The criteria for the diagnosis of cerebral infarction were examined and confirmed by the head MRI + DWI + MRA.2) The age was 45-80 years;3) the onset time was 3 days; and 4) the informed consent was signed. Exclusion criteria:1) age 45 years or 80 years:2) onset time 3 days;3) no head magnetic resonance examiners;4) cerebral hemorrhage, subarachnoid hemorrhage, intracranial venous (intracranial) thrombosis and other vascular diseases;5) patients with acute coronary syndrome; 6) concurrent severe heart, liver, lung, renal function impairment;7) pregnancy, trauma, infection, tumor or immune disease;8) without signing the informed consent form. 1.1.2 The observation component type is further classified according to the CISS type[11] to the observation group:1) the aorta atherosclerosis type (LAA), There were 56 cases (2) of the carotid artery disease (PAD),23 cases (3) of the cardiogenic stroke (CS),4 cases (4),4) other etiologies (OE),0 cases,5) the etiological factors (UE), A total of 7 cases were collected. All the cases were collected in the morning and the fasting venous blood was 3 ml. and the plasma Lp-PLA2 level, the plasma Lp-PLA2 level, the plasma Lp-PLA2 and other biochemical indexes were determined by using the EDTA (EDTA) anticoagulant, and the NORMAN series scattering turbidimetric analyzer and the lipoprotein phospholipase A2 measurement kit manufactured by the Nanjing Norman Biotech Co., Ltd. were used for measuring the plasma Lp-PLA2 and other biochemical indexes, And the operation flow is carried out according to the kit specification by adopting the immunopotentiation turbidimetry detection. The other biochemical indexes were used to determine the level of Chol, TG, LDL-C, HDL-C, Hcy, hs-CRP by the full-automatic biochemical analyzer in the United States. The median (quartile spacing) is used for the measurement data of the non-normal distribution, and t-test is used between the two groups of normal distribution, and the non-normal distribution is used for the rank sum test. The correlation between the two groups of one-way order data was compared with the Kruskal-Wallis test, and the correlation between the two groups was described by the Spearman rank correlation coefficient. The comparison of the count data between the two groups was tested by the 2-2 test, and the difference between the two groups was considered to be of statistical significance. Results: The age and sex ratio of the observation group and the control group were not statistically significant (P0.05). The levels of TG and LDL-C in the observation group and the control group were statistically different (P <0.05). The difference of TG and LDL-C in the observation group and the control group was not statistically significant (P0.05). The level of Chol and HDL-C in the control group was higher than that in the control group (P0.05). The difference of plasma Lp-PLA2 in the control group was not significant (P0.05). There was no statistical difference in the plasma Lp-PLA2 levels in the first and the relapse-type patients with acute ischemic stroke (P0.05). There was no significant correlation between plasma Lp-PLA2 level and hs-CRP (r = 0.766, P = 0.000), with the onset time, age, TG (r =-0.083, P = 0.440), Chol (r = 0.125, P = 0.244), HDL (r =-0.196, P = 0.066), LDL (r = 0.195, P = 0.068), Hcy (r =-0.036, P = 0.738). Conclusion: The plasma Lp-PLA2 level is not suggestive of the diagnosis and classification of acute ischemic stroke, and the plasma Lp-PLA2 level is positively correlated with hs-CRP. The relationship between Lp-PLA2 and hs-CRP has a significant correlation, and the correlation between Lp-PLA2 and LDL-C and HDL-C may need to be further studied.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R743.3
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