Lp-PLA2、sdLDL-C、25-OH-VD对静脉溶栓后缺血性脑卒中的神经损伤程度及预后预测价值

Predictive Value of Lp-PLA2, sdLDL-C and 25-OH-VD on the Degree of Neurological Impairment and Prognosis in Ischemic Stroke after Intravenous Thrombolysis

摘要

目的 探析脂蛋白相关磷脂酶A2（lipoprotein-associated phospholipasea2，Lp-PLA2）、小而密低密度脂蛋白胆固醇（small dense low-density lipoprotein，sdLDL-C）、25-羟基维生素D（25-hydroxyvitamin d，25-OH-VD）对静脉溶栓后缺血性脑卒中的神经损伤程度及预后预测价值。方法 回顾性分析2021年1月至2023年6月哈励逊国际和平医院收治的108例静脉溶栓后缺血性脑卒中患者的病案资料，按入院时美国国立卫生研究院卒中量表（national institute of health stroke scale，NIHSS）评分进行分组，分别为轻度组（49例，NIHSS<5分），中度组（35例，NIHSS 5～15分）、重度组（24例，NIHSS>15分）。采用酶联免疫吸附法测定Lp-PLA2、sdLDL-C、25-OH-VD的表达水平。Spearman分析法探析Lp-PLA2、sdLDL-C、25-OH-VD与神经损伤程度的关系，绘制受试者工作特征（receiver operating characteristic，ROC）曲线分析Lp-PLA2、sdLDL-C、25-OH-VD在严重程度、预后预测中的应用价值。结果 轻、中、重度缺血性脑卒中患者Lp-PLA2、sdLDL-C、NIHSS评分、梗死灶直径逐级升高，25-OH-VD逐级降低（P < 0.05）。Lp-PLA2、sdLDL-C与病情程度正相关，25-OH-VD呈负相关（P < 0.05）。三项指标联合评估脑卒中严重程度及预判不良预后的ROC效能均最优。结论 Lp-PLA2、sdLDL-C、25-OH-VD水平与静脉溶栓后缺血性脑卒中患者神经损伤程度密切相关，三者联合检测对患者病情严重程度及预后具有较高预测效能。

Abstract

Objective To explore the predictive value of lipoprotein-associated phospholipase A2 (Lp-PLA2), small dense low-density lipoprotein cholesterol (sdLDL-C), and 25-hydroxyvitamin D (25-OH-VD) on the degree of neurological impairment and prognosis in patients with ischemic stroke after intravenous thrombolysis. Methods A retrospective analysis was conducted on the medical data of 108 patients with ischemic stroke who received intravenous thrombolysis at Harrison International Peace Hospital from January 2021 to June 2023. Based on the National Institute of Health Stroke Scale (NIHSS) score at admission, patients were divided into mild group (NIHSS < 5, n = 49), moderate group (NIHSS 5–15, n = 35), and severe group (NIHSS > 15, n = 24). Serum levels of Lp-PLA2, sdLDL-C and 25-OH-VD were detected using enzyme-linked immunosorbent assay. Differences in Lp-PLA2, sdLDL-C and 25-OH-VD levels among groups were compared. Spearman correlation analysis was used to explore the relationship between Lp-PLA2, sdLDL-C, 25-OH-VD and the degree of neurological impairment. Receiver operating characteristic (ROC) curves were constructed to evaluate the value of Lp-PLA2, sdLDL-C and 25-OH-VD in assessing disease severity and predicting prognosis. Results The levels of Lp-PLA2, sdLDL-C, NIHSS score and infarct lesion diameter gradually increased, while 25-OH-VD level gradually decreased in the mild, moderate and severe groups (P < 0.05). Lp-PLA2 and sdLDL-C were positively correlated with disease severity of neurological injury, whereas 25-OH-VD was negatively correlated (P < 0.05). The combined detection of the three indicators showed the optimal ROC efficacy in assessing stroke severity and predicting poor prognosis. Conclusion Levels of Lp-PLA2, sdLDL-C and 25-OH-VD are closely associated with the degree of neurological impairment in patients with ischemic stroke after intravenous thrombolysis. The combined detection of the three indicators shows high predictive efficacy for disease severity and prognosis.

关键词

缺血性脑卒中 / 神经损伤程度 / 预后 / 脂蛋白相关磷脂酶 / 小而密低密度脂蛋白胆固醇 / 25-羟基维生素D

Key words

Ischemic stroke / Degree of neurological Impairment / Prognosis / Lipoprotein-associated phospholipase A2 / Small dense low-density lipoprotein cholesterol / 25-Hydroxyvitamin D

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基金资助

国家自然科学基金(82302879)

河北省卫健委医学科学基金(20261170)