摘要
目的 探讨血清脂蛋白相关磷脂酶A2(LP-PLA2)、基质金属蛋白酶-9(MMP-9)水平与2型糖尿病合并脑梗死患者颈动脉斑块易损性的相关性.方法 回顾性研究2020年2月至2023年1月在沧州市人民医院住院治疗的102例2型糖尿病合并脑梗死患者的临床资料,根据粥样斑块性质分组:50例患者为颈动脉斑块易损(易损组),52例患者为稳定性颈动脉斑块(稳定组).对比不同颈动脉斑块易损性患者的各项影响因素(性别、年龄、体重指数、合并高血压、合并高血脂症、血糖、血脂等);采用多因素Logistics回归分析影响颈动脉斑块易损性的因素;并以受试者操作特征(ROC)分析LP-PLA2、MMP-9单独及联合检查对颈动脉斑块易损性的预测价值.结果 稳定组与易损组患者的性别构成比、年龄、体重指数、合并高血压、合并高血脂症、甘油三酯、高密度脂蛋白胆固醇(HDL-C)比较,差异均无统计学意义(P＞0.05),易损组患者的空腹血糖、HbA1c、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、LP-PLA2、MMP-9水平分别为(6.19±0.88)mmol/L、(10.21±1.16)％、(4.87±0.87)mmol/L、(2.90±0.45)mmol/L、(363.16±52.78)pg/L、(83.36±11.29)pg/L,均明显高于稳定组[(5.81±0.44)mmol/L、(9.71±1.21)％、(4.51±0.55)mmol/L、(2.44±0.33)mmol/L、(292.44±47.27)pg/L、(60.46±9.85)pg/L],差异均有统计学意义(P＜0.05).多因素 Logistics 回归分析结果显示,HbA1c、LP-PLA2、MMP-9确定为影响2型糖尿病合并脑梗死患者颈动脉斑块易损性的独立因素(P＜0.05).LP-PLA2、MMP-9单独及联合检查预测颈动脉斑块易损性均有较高的准确性(P＜0.05).结论 糖尿病类型2合并脑梗死的患者颈动脉中存在不稳定的斑块的风险较高,而联合应用LP-PLA2与MMP-9作为标志物,对于颈动脉不稳定斑块的稳定性显现出较好的预测效果.
Abstract
Objective To analyze the correlation between serum levels of lipoprotein-associated phospholipase A2(LP-PLA2)and matrix metalloproteinase-9(MMP-9)and the vulnerability of carotid artery plaque in patients with type 2 diabetes mellitus complicated with cerebral infarction.Methods A retrospective study was conducted on the clinical data of 102 patients with type 2 diabetes mellitus complicated with cerebral infarction who were hospitalized in Cangzhou People's Hospital from February 2020 to January 2023.According to the nature of ather-osclerotic plaques,50 patients were vulnerable to carotid plate(vulnerable group),52 patients were stable carotid plaque(stable group).The in-fluencing factors(gender,age,body mass index,hypertension,hyperlipidemia,blood glucose,blood lipid,etc.)of patients with different ca-rotid plaque vulnerability were compared.The factors affecting the vulnerability of carotid plaque were analyzed by multivariate Logistics regression analysis.The predictive value of LP-PLA2 and MMP-9 alone and in combination to carotid plaque vulnerability was analyzed with receiver oper-ating characteristic(ROC)curve.Results There were no statistically significant differences in sex ratio,age,body mass index,hypertension,hyperlipidemia,triglyceride and high-density lipoprotein cholesterol(HDL-C)between the stable group and the vulnerable group(P＞0.05).The levels of fasting blood glucose,HbA1c,total cholesterol,low-density lipoprotein cholesterol(LDL-C),LP-PLA2 and MMP-9 in the vulnerable group were(6.19±0.88)mmol/L,(10.21±1.16)％,(4.87±0.87)mmol/L,(2.90±0.45)mmol/L,(363.16±52.78)pg/L and(83.36±11.29)pg/L,respectively.They were significantly higher than those in the stable group[(5.81±0.44)mmol/L,(9.71±1.21)％,(4.51±0.55)mmol/L,(2.44±0.33)mmol/L,(292.44±47.27)pg/L,(60.46±9.85)pg/L],the differences were statis-tically significant(P＜0.05).Only LP-PLA2 and MMP-9 were identified as independent factors affecting carotid plaque vulnerability in pa-tients with type 2 diabetes mellitus complicated with cerebral infarction(P＜0.05).HbA1c,LP-PLA2 and MMP-9 alone and in combination showed high accuracy in predicting carotid plaque vulnerability(P＜0.05).Conclusion Patients with diabetes type 2 complicated with cere-bral infarction have a higher risk of unstable plaque in the carotid artery.The combined application of LP-PLA2 and MMP-9 as markers show a better prediction effect for carotid artery unstable plaque.
基金项目
河北省2021年度医学科学研究课题计划项目(20210523)
沧州市重点研发计划自筹项目(213106030)
NETL
NSTL
万方数据