Relationship between carotid atherosclerotic plaque and plasma Lp-PLA2 level in patients with cerebral infarction based on high-resolution magnetic resonance scanning
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摘要:
目的 采用高分辨率MRI扫描法，探讨颈动脉粥样硬化(CAS)斑块影像学特征与脑梗死患者血浆脂蛋白相关磷脂酶A2(Lp-PLA2)水平的关系。 方法 选取2019年6月~2020年6月于我院收治的196例脑梗死患者为脑梗死组，另选取同期我院收治的无脑梗死患者40例为对照组，对比两组一般资料及斑块分布; 分析脑梗死组患者斑块性质; 根据斑块是否稳定将脑梗死患者分为稳定斑块组(n=61)、不稳定斑块组(n=123)和无斑块组(n=12)，对比3组生化指标(总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度蛋白胆固醇)及Lp-PLA2水平; 对比不同斑块分级(0级、1级、2级、3级)患者Crouse积分与Lp-PLA2水平; 采用Pearson分析法分析脑梗死患者Crouse积分与Lp-PLA2相关性。 结果 196例脑梗死患者中，184例(93.88%)有CAS斑块; 对照组40例中，9例(22.50%)有CAS斑块; 脑梗死组CAS斑块发生率高于对照组(P < 0.05); 稳定斑块组、不稳定斑块组和无斑块组生化指标中总胆固醇、三酰甘油、低密度脂蛋白胆固醇及Lp-PLA2表达水平均为无斑块组 < 稳定斑块组 < 不稳定斑块组(P < 0.05)，3组高密度脂蛋白胆固醇表达水平均为不稳定斑块组 < 稳定斑块组 < 无斑块组(P < 0.05); 脑梗死患者不同斑块分级Crouse积分和Lp-PLA2水平差异比较均有统计学意义(P < 0.05)，且Crouse积分和Lp-PLA2水平比较1级 < 2级 < 3级(P < 0.05); 经Pearson相关性分析结果显示：脑梗死患者斑块分级Crouse积分和Lp-PLA2水平呈正相关关系(P < 0.05)。 结论 脑梗死患者经高分辨率MRI扫描可显示CAS斑块大小和性质可见明显异常，且CAS斑块分级与血清Lp-PLA2水平有一定的相关性，血清Lp-PLA2水平可反映患者CAS斑块情况。 Abstract:Objective To investigate the relationship between the imaging characteristics of carotid atherosclerotic plaque (CAS) and plasma lipoprotein- associated phospholipase A2 (Lp-PLA2) in patients with cerebral infarction by high resolution MRI scanning. Methods A total of 196 patients with cerebral infarction admitted to our hospital from June 2019 to June 2020 were selected as the cerebral infarction group. Forty patients without cerebral infarction admitted to our hospital wards during the same period were selected as the control group. The general information and plaque distribution of the two groups were compared. The plaque properties of all patients with cerebral infarction were compared. Patients with cerebral infarction were divided into stable plaque group (n=61), unstable plaque group (n=123) and no plaque group (n=12) according to whether the plaque was stable. Biochemical indexes (total cholesterol, triglyceride, high density lipoprotein cholesterol, low density protein cholesterol) and Lp-PLA2 levels in the three groups were compared. Crouse score and Lp-PLA2 level in patients with different plaque grades (grade 0, 1, 2 and 3) were compared. The correlation between Crouse score and Lp-PLA2 in patients with cerebral infarction was analyzed by Pearson analysis. Results Among 196 patients with cerebral infarction, 184 (93.88%) had CAS plaque. Of the 40 in control group, 9 (22.50%) had CAS plaques; The incidence of CAS plaque in cerebral infarction group was higher than that in control group (P < 0.05). The expression levels of total cholesterol, triglyceride, low density protein cholesterol and Lp- PLA2 in the stable plaque group, the unstable plaque group and the non-plaque group were lower than that in the stable plaque group and the unstable plaque group (P < 0.05), and the high density lipoprotein cholesterol expression levels in the three groups were lower than that in the stable plaque group and the non-plaque group (P < 0.05). There were statistically significant differences in Crouse score and Lp-PLA2 level in different plaque grades of cerebral infarction patients (P < 0.05). The Crouse score and Lp-PLA2 level were compared in grade 1 < grade 2 < grade 3 (P < 0.05). The Pearson correlation analysis showed that there was a positive correlation between plaque grade Crouse score and Lp-PLA2 level in patients with cerebral infarction (P < 0.05). Conclusion High resolution MRI scan of cerebral infarction patients can show significant abnormalities in the size and nature of CAS plaques. There is a certain correlation between CAS plaque grade and serum Lp-PLA2 level, and serum Lp-PLA2 level can reflect the status of CAS plaques in patients. -
图 1 左侧颈内动脉(A~B)及右侧基底动脉(C)的HRMRI扫描图像
Figure 1. HRMRI scan images of left carotid artery (A-B) and right basilar artery (C).
图 2 脑梗死患者斑块分级Crouse积分和Lp-PLA2水平相关性
Figure 2. Correlation between plaque grade Crouse score and Lp-PLA2 level in patients with cerebral infarction.
表 1 两组一般资料对比
Table 1. Comparison of two groups of general data (n)
组别 性别 年龄(岁, Mean±SD) 糖尿病 高血压 吸烟 饮酒 男 女 脑梗死组(n=196) 101 95 60.49±6.31 93 84 57 43 对照组(n=40) 25 15 60.77±6.24 18 16 17 11 χ2/t 1.612 0.256 0.083 0.112 3.239 3.529 P 0.205 0.798 0.777 0.739 0.072 0.06 
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表 2 颈动脉斑块性质与CAS斑块分布情况
Table 2. Characteristics of Carotid artery plaque and distribution of CAS plaque (n)
组别 斑块分型 部位 颈总动脉 颈动脉分叉处 颈内动脉 脑梗死组(n=196) Ⅰ~Ⅱ型 12 12 18 Ⅲ型 24 6 18 Ⅳ~Ⅴ型 31 49 37 Ⅵ型 37 18 73 Ⅶ型 0 0 12 Ⅷ型 0 7 13 对照组(n=40) Ⅰ~Ⅱ型 3 8 9 Ⅲ型 0 0 2 Ⅳ~Ⅴ型 0 0 0 Ⅵ型 0 0 0 Ⅶ型 0 0 0 Ⅷ型 0 0 0 CAS: 颈动脉粥样硬化.
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表 3 3组生化指标及Lp-PLA2水平对比
Table 3. Comparison of biochemical indices and Lp-PLA2 levels among three groups (Mean±SD)
组别 TC(mmol/L) TG(mmol/L) HDL(mmol/L) LDL(mmol/L) Lp-PLA2(ng/mL) Fib(g/L) 无斑块组(n=12) 3.94±0.45 1.42±0.18 1.34±0.19 2.47±0.30 127.05±14.77 3.38±0.42 稳定斑块组(n=61) 4.54±0.56 1.59±0.20 1.35±0.20 2.49±0.31 176.93±19.28 3.43±0.44 不稳定斑块组(n=123) 5.08±0.61 2.01±0.22 1.19±0.15 3.15±0.37 216.98±24.59 3.46±0.46 F 32.906 107.693 20.664 84.433 130.433 0.229 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.796 TC: 总胆固醇; TG: 三酰甘油; HDL: 高密度脂蛋白胆固醇; LDL: 低密度蛋白胆固醇; Lp-PLA2: 脂蛋白相关磷脂酶A2.
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表 4 脑梗死患者斑块分级Crouse积分和Lp-PLA2水平比较
Table 4. Comparison of plaque grading Crouse score and Lp-PLA2 level in patients with cerebral infarction (Mean±SD)
组别 Crouse(分) Lp-PLA2(ng/mL) 1级(n=76) 3.26±0.37 166.42±18.18 2级(n=58) 3.94±0.43 212.59±24.20 3级(n=50) 4.58±0.51 243.59±27.62 F 144.354 179.201 P < 0.001 < 0.001
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