论文部分内容阅读
目的:探讨高海拔地区急性期缺血性脑卒中颈动脉易损斑块影像学特点与血清巨噬细胞趋化因子配体16(CXCL16)和脂蛋白相关磷脂酶A2(LP-PLA2)水平的关系。方法:2013年8月—2016年2月青海省人民医院神经内科收住院的128例缺血性脑卒中患者作为病例组,对照组为同期性别、年龄与病例组匹配的128例健康体检者。检测空腹血清LP-PLA2、CXCL16,并经颈动脉彩超筛查、颈动脉MRI检查记录颈动脉斑块分型。结果:在颈动脉存在斑块的95例患者中,颈动脉稳定斑块患者71例,其中(Ⅰ~Ⅱ)型斑块52例(52/95,54.7%),Ⅲ型斑块12例(12/95,12.6%),Ⅶ型斑块7例(7/95,7.4%)。颈动脉易损斑块患者24例,其中(Ⅳ~Ⅴ)型斑块9例(9/95,9.5%),Ⅵ型斑块15例(15/95,15.8%)。无斑块组、稳定斑块组、易损斑块组中,血清CXCL16水平及LP-PLA2水平呈逐渐递升的趋势,且对照组与稳定斑块组、对照组与易损斑块组之间,CXCL16[0.82(0.58,1.19)vs 1.16(0.69,2.42)vs 1.36(0.79,2.04)]及LP-PLA2[(7.71±2.89vs 11.59±3.97vs 13.13±3.38)]差异具有统计学意义(P<0.05),而对照组与无斑块组LPPLA2水平比较,差异无统计学意义(P>0.05),与CXCL16水平比较,差异具有统计学意义(P<0.05);与无斑块组相比:稳定斑块组、易损斑块组,血清CXCL16及LP-PLA2含量明显上调;稳定斑块组与易损斑块组相比:随着斑块易损性的增加,血清CXCL16及LP-PLA2水平升高,两组差异具有统计学意义(P<0.05)。结论:缺血性脑卒中颈动脉斑块的易损性与血清CXCL16、LP-PLA2水平升高相关。高场强MRI目前对颈动脉斑块分型是一种新的诊断方法,在区分稳定斑块及易损斑块中具有一定临床意义。
Objective: To investigate the relationship between the features of carotid vulnerable plaque and the levels of serum macrophage chemokine ligand 16 (CXCL16) and lipoprotein-associated phospholipase A2 (LP-PLA2) in acute ischemic stroke at high altitude relationship. Methods: From August 2013 to February 2016, 128 patients with ischemic stroke admitted to the Department of Neurology, People’s Hospital of Qinghai Province were enrolled in this study. The control group consisted of 128 healthy subjects with matched gender and age. Fasting serum LP-PLA2 and CXCL16 were detected by carotid ultrasonography, and carotid artery plaque was recorded by carotid artery MRI. Results: Of the 95 patients with carotid plaque, 71 patients had stable carotid plaques, including 52 (95% CI, 95% CI) and 12 (III) plaques 12 / 95,12.6%), Ⅶ plaque in 7 cases (7 / 95,7.4%). There were 24 patients with carotid vulnerable plaque, among which 9 (95%) were plaques (Ⅳ ~ Ⅴ) and 15% (15/155%) were plaque Ⅵ. CXCL16 level and LP-PLA2 level in non-plaque group, stable plaque group and vulnerable plaque group showed a trend of gradual increase, and between the control group and the stable plaque group, the control group and the vulnerable plaque group , P <0.05, P <0.05, P <0.05, P <0.05) .Conclusion: There is a significant difference between CXCL16 [0.82 (0.58,1.19) vs 1.16 (0.69,2.42) vs 1.36 (0.79,2.04)] and LP- PLA2 [(7.71 ± 2.89 vs 11.59 ± 3.97 vs 13.13 ± 3.38) <0.05). There was no significant difference between the control group and the non-plaque group (P> 0.05), but the difference was statistically significant (P <0.05) compared with the level of CXCL16. Compared with the non-plaque group : Stable plaque group, vulnerable plaque group, serum CXCL16 and LP-PLA2 levels were significantly increased; stable plaque group compared with vulnerable plaque group: with the increase of plaque vulnerability, serum CXCL16 and LP- PLA2 levels increased, the difference between the two groups was statistically significant (P <0.05). Conclusion: The vulnerability of carotid plaque in ischemic stroke is correlated with the increase of serum CXCL16 and LP-PLA2 levels. High-field MRI Currently, carotid plaque classification is a new diagnostic method, which has some clinical significance in distinguishing stable plaques and vulnerable plaques.