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LpPLA2、TNFα及CRP在急性缺血性脑卒中患者中的表达及意义
蒋月丽,解龙昌,梁冬,余靖一,庞明武,何超明
0
(海南省第三人民医院老年医学科;广州医科大学附属第二医院老年医学科)
摘要:
【摘要】目的 探讨脂蛋白磷脂酶A2(LpPLA2)、肿瘤坏死因子(TNFα)及C反应蛋白(CRP)在急性缺血性脑卒中患者中的表达及意义。方法 收集2016年10月~2017年6月在海南省第三人民医院接受治疗的1653例急性缺血性脑卒中患者为观察对象。按照1〖DK〗∶1〖DK〗∶1比例选择144例老年急性缺血性脑卒中患者为老年组(轻型组,n=78;重型组,n=66),144例中青年急性缺血性脑卒中患者为中青年组,144例健康体检查为对照组。检测3组血清LpPLA2、TNFα及CRP水平。使用Pearson分析三者之间的相关性,采用ROC曲线分析LpPLA2、TNFα及CRP诊断老年重型急性缺血性脑卒中的临床价值,并对影响患者预后的相关因素进行分析。结果 3组患者血清LpPLA2、TNFα及CRP水平比较差异有统计学意义(P<005)。重型组患者血清LpPLA2、TNFα及CRP水平高于轻型组(P<005)。患者血清LpPLA2与TNFα及CRP均呈正相关,TNFα与CRP呈正相关。ROC曲线分析显示,LpPLA2、TNFα及CRP诊断重型急性缺血性脑卒中曲线下面积(AUC)分别为0772、0790、0790;三者联合诊断重型急性缺血性脑卒中的曲线下面积为0878,联合检测AUC高于单独指标预测。单因素及多因素Logistic分析显示,年龄≥80岁、高血压、高LDLC、LpPLA2及CRP均为急性脑缺血性脑卒中患者预后不良的独立影响因素。结论 重型急性缺血性脑卒中患者血清LpPLA2、TNFα及CRP水平均显著升高,且三者与患者预后存在联系,其联合检测对急性缺血性脑卒中患者严重程度的临床诊断具有重要价值。
关键词:  急性缺血性脑卒中  脂蛋白磷脂酶A2  肿瘤坏死因子 α  C反应蛋白
DOI:
基金项目:海南省卫生适宜技术推广项目(1601032054C1004)
Expression of Lp PLA2, TNF α, CRP in cerebral ischemic stroke elderly patients and its significance
JIANG Yueli,XIE Longchang,LIANG Dong,YU Jingyi,PANG Mingwu,HE Chaoming
(Department of Geriatric Traditional Chinese Medicine, The Third People's Hospital of Hainan;Department of Geriatrics,The Second Affiliated Hospital of Guangzhou Medical University)
Abstract:
【Abstract】Objective To study the expression and significance of lipoprotein phospholipase A2 (LpPLA2), tumor necrosis factorα (TNFα) and Creactive protein (CRP) in elderly patients with acute ischemic stroke. Methods 1653 patients with acute ischemic stroke treated in our hospital from October 2016 to June 2017 were collected for observation. 144 elderly patients with acute ischemic stroke were in the elderly group. According to the ratio of 1:1:1, 144 young and middleaged patients with acute ischemic stroke were selected as the young and middleaged group, and 144 healthy subjects as the control group. Serum levels of LpPLA2, TNFα and CRP were measured in three groups. Pearson analysis was used to analyze the correlation between the three, and ROC curve was used to analyze the clinical value of LpPLA2, TNFα and CRP in the diagnosis of elderly patients with severe acute ischemic stroke, and the related factors affecting the prognosis of patients were analyzed. Results There were significant differences in serum LpPLA2, TNFα and CRP levels among the three groups (P<005). The order from high to low was senile group> middleaged group> control group (P<005). The serum levels of LpPLA2, TNFα and CRP in severe group were higher than those in light group (P<005). Serum LpPLA2 was positively correlated with TNFalpha and CRP, and TNFα was positively correlated with CRP. ROC curve analysis showed that the area under curve (AUC) of LpPLA2, TNFα and CRP in the diagnosis of severe acute ischemic stroke was 0772, 0790 and 0790, respectively. The area under curve of the combined diagnosis of severe acute ischemic stroke was 0878, and the combined detection of AUC was higher than the single index prediction. Univariate and multivariate logistic analysis showed that age> 80 years old, hypertension and high LDLC, LpPLA2, CRP were independent factors affecting the prognosis of patients with acute cerebral ischemic stroke. Conclusion Serum levels of LpPLA2, TNFα and CRP were significantly increased in patients with severe acute ischemic stroke, and there was a relationship between the three and the prognosis of patients. The combined detection of the three has important value in the clinical diagnosis of the severity of acute ischemic stroke.
Key words:  Cerebral ischemic stroke  Lipoprotein associated phospholipase A2  Tumor Necrosis Factor α  C reactive protein

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