Objective: To explore the relationship between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level and the risk of acute ischemic stroke (AIS) recurrence in hypertensive patients.
Methods: This retrospective case-control study was conducted among 211 hypertensive patients with AIS treated in Foshan First People's Hospital, including 35 patients with recurrence of AIS during the 1-year follow-up as confirmed by head CT/MR. In the overall patients, 60 had grade 1 hypertension (including 5 recurrent cases), 76 had grade 2 hypertension (with 11 recurrent cases), and 75 had grade 3 hypertension (with 19 recurrent cases). Univariate analysis, multivariate logistic regression analysis, trend analysis, and smooth curve fitting analysis were performed to explore the correlation between serum Lp-PLA2 level within 24 h after admission and the risk of AIS recurrence. The predictive efficacy of serum Lp-PLA2 level for AIS recurrence in different hypertension grades was evaluated using ROC curve analysis.
Results: Serum Lp-PLA2 level, age, NIHSS score at admission, mRS scores at 7 days, homocysteine level and smoking status differed significantly between patients with and without AIS recurrence (P < 0.05). After adjustment for confounding factors, multivariate regression analysis showed that the highest tertile of Lp-PLA2 level was associated with a 4.13-fold increase of AIS recurrence risk compared with the lowest tertile (OR=5.13, 95% CI: 1.35-19.40), and each 1 ng/mL increase of Lp-PLA2 level was associated with a 1% increase of AIS recurrence risk (OR= 1.01, 95% CI: 1.01-1.02). Serum Lp-PLA2 level was shown to positively correlate with AIS recurrence risk, and in patients with grade 3 hypertension, its areas under the ROC curve for predicting AIS recurrence was 0.869 with a specificity of 0.893 and a sensitivity of 0.737.
Conclusion: Serum Lp-PLA2 concentration is an independent risk factor and potentially an effective predictor for AIS recurrence in patients with grade 3 hypertension.
目的: 探究在伴高血压的急性缺血性脑卒中（AIS）患者中，血清脂蛋白相关磷脂酶A2（Lp-PLA2）浓度及复发风险之间的相关性。
方法: 采用回顾性病例对照研究，纳入211例确诊伴高血压的急性脑梗死患者，入院24 h内检测血清Lp-PLA2浓度, 对纳入研究的患者进行1年随访观察，根据头颅CT/MR证实脑梗死复发而分为复发组（35例）和非复发组（176例），根据高血压分级分为3组，分别为1级高血压组（60例，复发5例）、2级高血压组（76例，复发11例）、3级高血压组（75例，复发19例）。单因素分析两组间的临床资料及Lp-PLA2浓度，采用多因素logistic回归分析、趋势性分析、平滑曲线拟合分析血清Lp-PLA2浓度与伴高血压的急性脑梗死复发风险的相关性，采用ROC曲线对不同高血压分级伴AIS中Lp-PLA2浓度与复发风险进行预测效能评价。
结果: 与非复发组对比，复发组中血清Lp-PLA2浓度、年龄、入院时NHISS评分、7 d时mRS评分、HCY、吸烟间的差异有统计学意义（P < 0.05）。多因素回归分析中，当调整混杂因素后，与Lp-PLA2最低三分位组相比，Lp-PLA2最高三分位组的复发风险增加了4.13倍（OR=5.13，95% CI：1.35~19.40），而当Lp-PLA2作为连续变量时，Lp-PLA2每增加1 ng/mL，伴高血压的缺血性脑卒中患者复发风险增加1%(OR=1.01 95% CI：1.01~1.02）。平滑曲线显示Lp-PLA2浓度与高血压合并脑梗死的复发风险呈正相关。Lp-PLA2浓度预测3级高血压伴AIS患者复发风险的ROC曲线下面积为0.869，特异度为0.893，敏感度为0.737。
结论: 血清Lp-PLA2浓度是伴高血压的急性脑梗死患者复发风险的独立危险因素，且可能是3级高血压伴AIS复发风险的有效预测指标。
Keywords: correlation analysis; ischemic stroke with hypertension; lipoprotein-associated phospholipase A2; recurrence.