International Medicine and Health Guidance News ›› 2022, Vol. 28 ›› Issue (4): 475-479.DOI: 10.3760/cma.j.issn.1007-1245.2022.04.008

• Scientific Research • Previous Articles     Next Articles

Serum Lp-PLA2 level on admission for predicting early stroke risk after transient ischemic attack

Qian Mingyue, Zhang Haojiang, Ge Zhonglin, Yu Shanhua   

  1. Department of Neurology, The Second People's Hospital of Lianyungang, Lianyungang 222000, China

  • Received:2021-12-07 Online:2022-02-15 Published:2022-03-15
  • Contact: Zhang Haojiang, Email: 275465553@qq.com
  • Supported by:
    Clinical Science and Technology Development Fund of Jiangsu University (JLY20160174)

入院血清Lp-PLA2水平预测短暂性脑缺血发作后早期卒中风险

钱明月  张浩江  葛中林  于善花   

  1. 连云港市第二人民医院神经内科,连云港 222000
  • 通讯作者: 张浩江,Email:275465553@qq.com
  • 基金资助:
    江苏大学临床科技发展基金(JLY20160174)

Abstract: Objective To investigate the predictive value of serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level on admission for early stroke risk after transient ischemic attack (TIA). Methods A total of 179 TIA patients were retrospectively enrolled in Department of Neurology, The Second People's Hospital of Lianyungang from August 2015 to November 2019, including 100 males and 79 females, aged (66.2±7.8) years. TIA patients were divided into a stroke group (28 cases) and a non-stroke group (151 cases) after 3 months of follow up. Multivariate logistic regression analysis was used to identify the independent risk factors for stroke. The receiver operating characteristic curve (ROC) was used to analyze the predictive value of Lp-PLA2 for stroke risk after TIA. Independent sample t test was used for inter-group comparison of the measurement data conforming to normal distribution, Mann-Whitney U test was used for inter-group comparison of the measurement data conforming to abnormal distribution, and χ2 test or Fisher's exact test was used for inter-group comparison of the count data. Results The baseline systolic blood pressure, serum LP-PLA2 level, proportion of duration of symptom ≥60 min, ABCD2 score, vascular stenosis rate, and unstable plaque rate in the stroke group were (158.4±27.4) mmHg (1 mmHg=0.133 kPa), (286.5±18.9) μg/L, 39.2% (11/28), 6.00 (5.00, 6.00) points, 78.6% (22/28), and 78.6% (22/28), higher than those in the non-stroke group [(146.3±25.2) mmHg, (230.5±17.2) μg/L, 13.2% (20/151), 4.00 (3.00, 5.00) points, 36.4% (55/151), and 38.4% (58/151)], and the usage rate of dual antiplatelet drugs was 60.0% (15/28), lower than that in the non-stroke group [83.3% (115/151)], with statistically significant differences (all P<0.05). After adjusting for confounders, multivariate logistic regression analysis showed that baseline systolic blood pressure, LP-PLA2, duration of symptoms ≥60 min, ABCD2 score, vascular stenosis, and unstable plaque were independent risk factors for stroke (all OR>1), and dual antiplatelet therapy was a protective factor for stroke (OR<1). The area under curve of LP-PLA2 for predicting early stroke was 0.752 (95%CI: 0.657-0.848; Z=5.142, P<0.001), the optimal cut-off value was 212.6 μg/L, the sensitivity was 85.66%, and the specificity was 52.67%. Conclusion Higher serum Lp-PLA2 level on admission is an independent risk factor of early stroke after TIA, and has predictive value for early stroke risk after TIA.

Key words: Lipoprotein-associated phospholipase A2, Transient ischemic attack, Early stroke risk

摘要: 目的 探讨入院血清脂蛋白相关磷脂酶A2(Lp-PLA2)预测短暂性脑缺血发作(TIA)后早期卒中发生风险的价值。方法 回顾性连续收集2015年8月至2019年11月在连云港市第二人民医院神经内科住院的TIA患者179例,其中男100例,女79例,年龄(66.2±7.8)岁。根据TIA发病后90 d随访是否发生卒中分为卒中组28例和非卒中组151例。多变量logistic回归分析确定卒中发生的独立危险因素,进一步采用受试者工作特征曲线(ROC)分析Lp-PLA2预测卒中发生的价值。符合正态分布的计量资料组间比较采用独立样本t检验,不符合正态分布的计量资料组间比较采用Mann-Whitney U检验,计数资料组间比较采用χ2检验或Fisher精确检验。结果 卒中组患者基线收缩压、血清Lp-PLA2水平、症状持续时间≥60 min比例、ABCD2评分、血管狭窄率、不稳定斑块率分别为(158.4±27.4)mmHg(1 mmHg=0.133 kPa)、(286.5±18.9)μg/L、39.2%(11/28)、6.00(5.00,6.00)分、78.6%(22/28)、78.6%(22/28),均高于非卒中组(146.3±25.2)mmHg、(230.5±17.2)μg/L、13.2%(20/151)、4.00(3.00,5.00)分、36.4%(55/151)、38.4%(58/151),而双抗血小板使用率为60.0%(15/28),低于非卒中组83.3%(115/151),差异均有统计学意义(均P<0.05)。调整混杂因素后多变量logistic回归分析显示基线收缩压、LP-PLA2、症状持续时间≥60 min、ABCD2评分、血管狭窄、不稳定斑块为卒中发生的独立危险因素(均OR>1),双抗血小板治疗为卒中发生的保护性因素(OR<1)。Lp-PLA2预测早期卒中的曲线下面积为0.752(95%CI:0.657~0.848;Z=5.142,P<0.001),最佳截断值为212.6 μg/L,灵敏度为85.66%,特异度为52.67%。结论 Lp-PLA2是TIA患者出现早期卒中发生的独立危险因素,且对早期卒中的发生有一定的预测价值。

关键词: 脂蛋白相关磷脂酶A2, 短暂性脑缺血发作, 早期卒中风险