河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (12): 1378-1383.doi: 10.3969/j.issn.1007-3205.2022.12.003

• • 上一篇    下一篇

老年H型高血压伴急性脑梗死患者外周血LP-PLA2、S100-β与病情严重程度及预后的关系分析

  

  1. 江苏省常州市老年病医院，常州第七人民医院神经内科，江苏 常州213011

  • 出版日期:2022-12-25 发布日期:2023-01-11
  • 作者简介:张红金（1978-），男，江苏常州人，江苏省常州市老年病医院副主任医师，医学学士，从事神经内科疾病诊治研究。
  • 基金资助:
    江苏省自然科学基金项目（Kh2018020）

Analysis of the relationship of LP-PLA2 and S100-β in peripheral blood of elderly patients with H-type hypertension and acute cerebral infarction with the severity and prognosis of the disease

  1. Department of Neurology,  Geriatric Hospital of Changzhou City/ the Seventh People′s Hospital of Changzhou City, Jiangsu Province, Changzhou 213011, China
  • Online:2022-12-25 Published:2023-01-11

HTML

PDF (PC)

55

摘要： 目的 探讨老年H型高血压伴急性脑梗死患者外周血脂蛋白相关磷脂酶A2（lipoprotein associated phospholipase A2，LP-PLA2）、中枢神经特异蛋白（central nerve specific protein，S100-β）与病情严重程度及预后的关系。
方法 选取江苏省常州市老年病医院收治的老年H型高血压伴急性脑梗死患者96例、老年H型高血压患者85例和同一时间段在本院进行体检的健康者80例分别记为H型高血压伴急性脑梗死组、H型高血压组和健康组。对比3组研究对象临床资料及外周血LP-PLA2、S100-β水平。依据脑梗死面积将老年H型高血压伴急性脑梗死患者分为轻度梗死组、中度梗死组及重度梗死组3个亚组，依据预后情况将老年H型高血压伴急性脑梗死患者分为预后不良组和预后良好。对比不同梗死程度老年H型高血压伴急性脑梗死患者外周血LP-PLA2、S100-β水平。对比预后良好组和预后不良组患者的临床资料。Logistic多因素回归分析影响老年H型高血压伴急性脑梗死患者患者预后的危险因素。制作受试者工作特征曲线（receiver operating characteristic curve，ROC），分析外周血LP-PLA2、S100-β及两者联合预测老年H型高血压伴急性脑梗死患者预后不良的价值。
结果 H型高血压伴急性脑梗死组、H型高血压组收缩压、舒张压、同型半胱氨酸（homocysteine，Hcy）、LP-PLA2及S100-β水平均高于健康组（P＜0.05）。H型高血压伴急性脑梗死组、H型高血压组LP-PLA2、S100-β水平均高于健康组（P＜0.05）。H型高血压伴急性脑梗死组LP-PLA2、S100-β水平又均高于H型高血压（P＜0.05）。重度梗死组外周血LP-PLA2、S100-β水平均高于轻度梗死组、中度梗死组（P＜0.05），中度梗死组外周血LP-PLA2、S100-β又均高于轻度梗死组（P＜0.05）。老年H型高血压伴急性脑梗死患者预后不良发生率为33.33%。预后不良组高血压分级Ⅲ级占比、糖化血红蛋白（glycosylated hemoglobin，HbA1c）、外周血LP-PLA2及S100-β水平高于预后良好组（P＜0.05），预后不良组尿酸（uric acid，UA）水平则低于预后良好组（P＜0.05）。Logistic回归分析结果显示，UA、外周血LP-PLA2及S100-β水平均为影响老年H型高血压伴急性脑梗死患者预后不良的危险因素（OR=2.861、3.370、3.483，P＜0.05）。ROC分析显示，外周血LP-PLA2、S100-β两者联合预测老年H型高血压伴急性脑梗死患者预后不良的曲线下面积（area under curve，AUC）为0.851，高于外周血LP-PLA2、S100-β水平单独预测的AUC（P＜0.05）。
结论 外周血LP-PLA2、S100-β与老年H型高血压伴急性脑梗死患者病情严重程度及预后均有关，且外周血LP-PLA2、S100-β对老年H型高血压伴急性脑梗死预后预测的效能较高，可作为对该类患者预后情况进行评估的重要参考指标。


关键词: 脑梗死, 急性, H型高血压, 老年人

Abstract: Objective To investigate the relationship of peripheral blood lipoprotein-related phospholipase A2 (LP-PLA2) and central nervous system specific protein (S100-β)in peripheral blood with the severity and prognosis of elderly patients with H-type hypertension（HHT） and acute cerebral infarction (ACI). 
Methods Ninety-six elderly patients with HHT and ACI and 85 elderly patients with HHT treated in Geriatric Hospital of Changzhou City, Jiangsu Province, as well as 80 healthy patients who underwent physical examination in the hospital during the same period were selected as HHT + ACI group, HHT group, and healthy group, respectively. The clinical data and peripheral blood LP-PLA2 and S100-β levels of the three groups were compared. According to the area of cerebral infarction, elderly patients with HHT and ACI were divided into three subgroups: mild infarction group, moderate infarction group, and severe infarction group. According to the prognosis, the elderly patients with HHT and ACI were divided into poor prognosis group and good prognosis group. The peripheral blood LP-PLA2 and S100-β levels of elderly patients with HHT and ACI with different infarction degrees were compared. The clinical data in good prognosis group and poor prognosis group were compared. Multivariate Logistic regression analysis was used to analyze the risk factors affecting the prognosis of elderly patients with HHT and ACI. The receiver operating characteristic (ROC) curve was drawn to analyze the value of peripheral blood LP-PLA2, S100-β and the combination of the two in predicting the poor prognosis of elderly patients with HHT and ACI. 
Results The systolic blood pressure, diastolic blood pressure, homocysteine (Hcy), LP-PLA2 and S100-β levels of the HHT + ACI group and HHT group were higher than those of the healthy group (P＜0.05). LP-PLA2 and S100-β in the HHT + ACI group and HHT group were higher than those in the healthy group (P＜0.05). LP-PLA2 and S100-β were higher in HHT + ACI group than in HHT group (P＜0.05). The levels of peripheral blood LP-PLA2 and S100-β in the severe infarction group were higher than those in the mild and moderate infarction groups (P＜0.05). The peripheral blood LP-PLA2 and S100-β in the moderate infarction group were higher than those in the mild infarction group (P＜0.05). The incidence of poor prognosis in elderly patients with HHT and ACI was 33.33%. The proportion of hypertension grade Ⅲ, glycosylated hemoglobin (HbA1c), peripheral blood LP-PLA2 and S100-β levels in the poor prognosis group were higher than those in the good prognosis group (P＜0.05), while the uric acid (UA) level in the poor prognosis group was lower than the good prognosis group (P＜0.05). Logistic regression analysis showed that UA, peripheral blood LP-PLA2 and S100-β levels were all risk factors affecting the prognosis of elderly patients with HHT and ACI (OR=2.861, 3.370, 3.483, P＜0.05). ROC analysis showed that the area under the ROC curve (AUC) of combined detection of peripheral blood LP-PLA2 and S100-β in predicting poor prognosis of elderly patients with HHT and ACI was 0.851, which was higher than that of peripheral blood LP-PLA2 and S100-β alone (P＜0.05). 
Conclusion Peripheral blood LP-PLA2 and S100-β are related to the severity and prognosis of elderly patients with HHT and ACI. In addition, peripheral blood LP-PLA2 and S100-β have higher efficiency in predicting the prognosis of elderly patients with HHT and ACI, which can be used as important reference indexes for evaluating the prognosis of these patients.


Key words: cerebral infarction, acute, H-type hypertension, elderly

版权所有 © 《河北医科大学学报》编辑部
本系统由北京玛格泰克科技发展有限公司设计开发