血浆Lp-PLA2对急性缺血性脑卒中诊断的临床研究
发布时间：2019-07-06 08:46
【摘要】：目的:缺血性脑卒中的诊断主要依靠患者的症状/体征以及CT/MRI等影像学检查,目前临床仍缺乏快速、敏感以及特异性的血液生化学指标。最新研究表明炎性反应是导致动脉粥样硬化和缺血性卒中的重要机制之一,人血浆脂蛋白相关磷脂酶A2(Lp-PLA2)由单核巨噬细胞产生,参与氧化低密度脂蛋白的代谢,促进血管特异性炎症和粥样硬化的进程,有可能是提示缺血性脑卒中的发生及动脉粥样硬化型脑卒中的重要依据。本研究应用免疫增强比浊法检测急性缺血性脑卒中患者血浆Lp-PLA2水平,并与健康体检者对比,以探讨血浆Lp-PLA2水平是否具有提示急性缺血性脑卒中的诊断及分型的价值,为急性缺血性卒中的诊断提供新的思路,同时为进一步个体化治疗提供理论依据。方法:1材料1.1研究对象选取河北医科大学第二医院神经内科2014年12月至2015年12月住院的急性缺血性脑卒中病人90例为观察组,其中男性74例,女性16例,年龄45~80岁,平均年龄58.58±8.46岁。就诊时间为发病后4小时~3天。首次发病者66例,复发者24例。另一组为我院体检中心健康体检者90例为对照组,其中男性74例,女性16例,年龄45~80岁,平均年龄59.30±8.43岁。1.1.1入排标准入组标准:1)观察组的患者均符合1995年全国第4届脑血管病学术会议所制定的《各类脑血管疾病诊断要点》脑梗死诊断标准,均行颅脑MRI+DWI+MRA检查并证实;2)年龄45~80岁;3)发病时间3天;4)签署知情同意书。排除标准:1)年龄45岁或80岁:2)发病时间3天;3)无法行头颅磁共振检查者;4)脑出血、蛛网膜下腔出血、颅内静脉(窦)血栓形成等其它血管疾病者;5)并发急性冠脉综合征患者;6)并发严重的心、肝、肺、肾功能损害;7)妊娠、创伤、感染、肿瘤或免疫性疾病者;8)未签署知情同意书者。1.1.2观察组分型根据CISS分型[11]对观察组进一步分型:1)大动脉粥样硬化型(LAA),分为主动脉弓粥样硬化及颅内外大动脉粥样硬化,共56例;2)穿支动脉疾病(PAD),共23例;3)心源性卒中(CS),共4例;4)其他病因(OE),共0例;5)不确定病因(UE),共7例。2实验方法2.1标本采集所有病例入院后均采取晨起空腹静脉血3ml,并经乙二胺四乙酸(EDTA)抗凝,5小时内完成免疫增强比浊法测定血浆Lp-PLA2水平。2.2血浆Lp-PLA2及其他生化指标测定采用南京诺尔曼生物技术有限公司生产的NORMAN系列散射比浊分析仪和脂蛋白磷脂酶A2测定试剂盒,采用免疫增强比浊法检测,操作流程按试剂盒说明书进行。其他生化指标应用美国全自动生化分析仪测定Chol、TG、LDL-C、HDL-C、Hcy、hs-CRP水平。3统计学方法采用SPSS 21.0统计软件对实验数据进行统计学分析,符合正态分布的计量资料用均数±标准差表示,非正态分布的计量资料则用中位数(四分位间距)表示,正态分布的两组组间比较用t检验,非正态分布者用秩和检验。两组间单向有序等级资料比较用Kruskal-Wallis检验,等级资料的相关性分析用Spearman秩相关系数描述相关性。两组间计数资料的比较用χ2检验,P0.05认为差异具有统计学意义。结果:1观察组和对照组的年龄、性别构成比、饮酒比例经t检验或χ2检验,差异无统计学意义(P0.05)。观察组和对照组的吸烟、高血压、糖尿病比例经χ2检验均具有统计学差异(P0.05)。2观察组和对照组血浆TG、LDL-C水平经秩和检验差异无统计学意义(P0.05)。对照组Chol和HDL-C水平比观察组高,经秩和检验或t检验均具有统计学差异(P0.05)。3观察组与对照组血浆Lp-PLA2水平差异无统计学意义(P0.05)。4男性与女性患者分别进行观察组与对照组Lp-PLA2水平比较(P0.05),无统计学差异。5首发型及复发型急性缺血性脑卒中患者与对照组血浆Lp-PLA2水平比较均无统计学差异(P0.05),首发型与复发型比较亦无统计学差异(P0.05)。6观察组LAA型、PAD型、对照组组间比较(P0.05),差异无统计学意义。7血浆Lp-PLA2水平与hs-CRP呈显著正相关(r=0.766,P=0.000),与发病时间、年龄、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)无明显相关性。结论:血浆Lp-PLA2水平对急性缺血性脑卒中的诊断及分型无提示意义;血浆Lp-PLA2水平与hs-CRP显著正相关。Lp-PLA2与hs-CRP具有显著相关性;Lp-PLA2水平与LDL-C、HDL-C的相关性可能尚需进一步研究明确。
文内图片：
图片说明：男性，57岁，，穿支动脉疾病型缺血性脑卒中
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3
文内图片：
图片说明：男性，57岁，，穿支动脉疾病型缺血性脑卒中
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3
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