脂蛋白相关磷脂酶A_2和C反应蛋白与短暂性脑缺血发作患者风险分层的研究被引量：14

Role of lipoprotein-related phospholipase A_2 and hs-CRP in risk stratification of patients with transient ischemic attack

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摘要目的明确脂蛋白相关磷脂酶A2（Lp-PLA2）和高敏C反应蛋白（hs-CRP）是否有助于改善短暂性脑缺血发作（TIA）患者风险分层,提高预后预测能力。方法选择急诊入院的132例TIA患者,分为阳性事件组34例和阴性事件组98例。2组均进行ABCD2评分,0~3分为低危患者46例,4~5分为中危患者70例,6~7分为高危患者16例。检测Lp-PLA2含量、活性及hs-CRP水平。主要结局采用复合终点分析,90d内脑卒中或死亡及与症状相关≥50%大动脉狭窄或有心源性栓子需要抗凝治疗。结果与阴性事件组比较,阳性事件组Lp-PLA2含量和活性明显升高（P〈0.05）。有大动脉硬化者Lp-PLA2含量和活性较无大动脉硬化者明显升高（P〈0.05）。ABCD24~5分[RR=2.18,95%CI：1.26~3.61,P=0.008];ABCD2评分6~7分[RR=3.43,95%CI：1.91~6.39,P=0.001]Lp-PLA2活性〉33μmol/（L·min）[RR=2.73,95%CI：1.04~7.06,P=0.042]是TIA患者复合终点事件的预测因素。结论 Lp-PLA2检测和ABCD2评分法结合可提高TIA患者90d内发生脑卒中或死亡的预测能力。 Objective To study whether lipoprotein-related phospholipase A2 and hs-CRP can improve the risk stratification and outcome in transient ischemic attack（TIA）patients.MethodsOne hundred and thirty-two TIA patients admitted to our hospital were divided into positive event group（n=34）and negative event group（n=98）.The patients were scored according to the ABCD2 and further divided into low risk group with 0-3ABCD2 scores（n=46）,moderate risk group with 4-5ABCD2 scores（n=70）and high risk group with 6-7ABCD2 scores（n=16）.Their serum Lp-PLA2 actiity and hs-CRP level were measured.Their primary outcomes were analyzed by composite endpoint analysis.The incidence of ischemic stroke or death within 90 days was calculated in patients with their conducting artery stenosis≥50% or cardiogenic embolism needing anticoagulation treatment.Results The serum Lp-PLA2 activity was significantly higher in positive event group than in negative event group and in patients with their conducting artery stenosis≥50%than in those with no conducting artery stenosis（P〈0.05）.Composite endpoint analysis showed that 4-5ABCD2 scores,6-7ABCD2 scores,and Lp-PLA2activity〉33μmol/（L·min）were the risk factors for composite end events in TIA patients（RR=2.18,95%CI：1.26-3.61,P =0.008;RR =3.43,95%CI：1.91-6.39,P =0.001;RR =2.73,95%CI：1.04-7.06,P=0.042）.Conclusion Lp-PLA2 activity in combination with ABCD2 score can predict ischemic stroke and death within 90 days in TIA patients.

作者赵振强胡兰蔡美华陈志斌王淑荣王埮陈小武

机构地区海南医学院附属医院神经内科海南医学院附属医院检验科

出处《中华老年心脑血管病杂志》 CAS 2015年第4期365-368,共4页 Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基金海南省自然科学基金(811217) 海南省重大科技项目(ZDZX2013003) 海南医学院科研培育基金(HY2010-025)

关键词脂蛋白类磷脂酶A2 C反应蛋白质脑缺血发作短暂性卒中抗凝药 lipoproteins phospholipases A2 C-reactive protein ischemic attack transient stroke anticoagulants

分类号 R743.3 [医药卫生—神经病学与精神病学]

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1Johnston SC, Rothwell PM, Nguyen Huynh MN, et al. Vali- dation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet, 2007,369:283- 292.
2Purroy F, Molina CA, Montaner J, et al. Absence of useful ness of ADCD score in the early risk of stroke of transient is chemic attack patients. Stroke, 2007,38 : 855-856.
3Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attacka systematic review and meta-analysis. Lan eet Neurol, 2007,6 : 1063-1072.
4Cucchiara BL, Messe SR, Sansing L, et al. Lipoprotein-associ- ated phospholipase A2 and C-reactive protein for risk stratifi cation of patients with TIA. Stroke, 2009,40 : 2332-2336.
5Mannheim D, Herrmann J, Versari D, et al. Enhanced expres sion of I.p PLA2 and lysophosphatidylcholine in symptomatic carotid atherosclerotic plaques. Stroke, 2008,39 : 1448-1455.
6Holzer K, Feurer R, Sadikovic S, et al. Prognostic value of the ABCD2 score beyond short-term follow up after transient is-chemic attack (T1A)- a cohort sludy. BMC Neurol,2011,10: 50.
7Lanman RB,Wolfert RL,Fleming JK,et a]. I./poprotein asso ciated phospholipase A2: review and recommendation of a clinical cut point for adults. Prevent Cardiol,2006,9:138 14.3.
8Brilakis ES, Khera A, McGuire I)K,et al. Influence of race and sex on lipoprotein associated phospholipase A2 levels:oh servations from the dallas heart study. Atherosclerosis, 2008, 199:110-115.
9Elkind MS,Tai W,Coates K,et al. High sensitivity C reactive protein,lipoproteiwassoeiated phospholipase A2, and outcome after ischemic stroke. Arch Intern Med, 2006, 166: 2073-2080.
10Ballantyne CM, Hoogeveen RC, Bang H, et al. Lipoprotein as sociated phospholipase A2, high-sensitivity C-reactive pro tein,and risk for incident ischemic stroke in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study. Arch Intern Med,2005,165:2479-2484.

二级参考文献59

1高晶,郭玉璞,赵庆杰,任海涛,赵燕环.颅内动脉粥样硬化的分布及炎性因素探讨[J].中华神经科杂志,2006,39(7):459-462. 被引量：20
2各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380. 被引量：33092
3丁则昱,李晓光,崔丽英,张承训,鄢盛恺,朱以诚,陈琳.急性期高敏感C反应蛋白对脑梗死预后的评估[J].中华神经科杂志,2007,40(1):11-14. 被引量：70
4Thompson SG K J, Pyke SDM, Haverkate F, et al. The European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pcctoris. N Engl J Med, 1995, 332: 635-641.
5Haverkate F, Thompson SG, Pyke SD, et al. Production of Creactive protein and risk of coronary events in stable and unstable angina. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet, 1997, 349 : 462 -466.
6Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med, 2005, 352: 1685-1695.
7Ridker PM, Cushman M, Stampfer M J, et al. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med, 1997, 336: 973-979.
8Mega JL, Morrow DA, Cannon CP, et al. Cholesterol, C-reactive protein, and cerebrovascular events following intensive and moderate statin therapy. J Thromb Thrombolysis, 2006, 22: 71-76.
9Ridker PM, Cannon CP, Morrow D, et al. The pravastatin or atorvastatin evaluation and infection therapy thrombolysis in myocardial infarction 22 ( PROVE IT-TIMI 22 ) investigators. Creactive protein levels and outcomes after statin therapy. N Engl J Med, 2005, 352: 20-28.
10Di Napoli M, Papa F, Bocola V. C-reactive protein in ischemic stroke: an independent prognostic factor. Stroke, 2001,32: 917- 924.