【摘要】 目的研究急性脑梗死（acute cerebral infarction,ACI）患者ApoE基因多态性分布特点,并探讨与脂蛋白相关磷脂酶A₂（lipoprotein-associated phospholipase A₂,Lp-PLA₂）表达的相关性。方法采用病例对照研究方法,选取2015年7月至2017年6月聊城市第三人民医院神经内科112例ACI患者和59例年龄匹配的查体健康者。应用核酸探针杂交芯片技术检测ApoE的基因分型,采用上转发光技术测定血清Lp-PLA₂。结果对照组ApoE的E2、E3和E4等位基因频率分别为21.19%、73.73%和5.08%。Apo E基因型频率符合Hardy-Weinberg平衡。ACI组与对照组比较,E2等位基因频率（6.25%）低于对照组（21.19%）,差异具有统计学意义（P<0.01）;ε2/2、ε2/3基因分型均低于对照组,差异具有统计学意义（P<0.05）;ε3/4基因分型高于对照组,差异具有统计学意义（P<0.05）。Lp-PLA₂表达对照组（106.16±38.85 ng/ml）与ACI组（146.39±57.90 ng/ml）差异有统计学意义（P<0.01）。两组间E4等位基因与非E4等位基因Lp-PLA₂浓度两两比较:对照组E4等位基因携带者与ACI组非E4患者比较（P=0.153）,差异无统计学意义（P>0.05）;其他各组间差异均有统计学意义（P<0.01）。Lp-PLA₂表达与ACI患者ROC曲线诊断价值分析:AUC值为0.790,95%CI（71.9,86.1）,临床诊断临界点为123.01 ng/ml,敏感度为67.8%,特异度为69.6%,Lp-PLA₂表达水平对判断ACI的发生有统计学意义（P<0.01）。Logistic回归分析显示:Lp-PLA₂与ApoE E4等位基因均为ACI诊治的危险因素。结论 ApoE E4等位基因携带为ACI的风险因子,Lp-PLA₂表达与ACI患者密切相关;检测ApoE基因型及血清Lp-PLA₂表达对诊断ACI发生有一定的临床意义。更多还原

【Abstract】 Objective To investigate the distribution of ApoE gene polymorphism in patients with acute cerebral infarction（ACI） and to explore the its correlation with the expression of lipoprotein-associated phospholipase A₂（Lp-PLA₂）. Methods A case-control study was conducted in 112 ACI inpatients that visited the Department of Neurology, the Third People′s Hospital of Liaocheng from July 2015 to June 2017 and 59 age-matched healthy subjects were included as control. Nucleic acid probe hybridization chips were used to detect the genotypes of ApoE and serum Lp-PLA₂ was measured by the up-converting luminescence technique. Results The allele frequencies of ApoE E2, E3 and E4 in the control group were 21.19%, 73.73% and 5.08%, respectively. The genotype frequency of ApoE conforms to the balance of Hardy-Weinberg. The frequency of E2 allele in ACI group（6.25%） was significantly lower than that in control group（21.19%）（P < 0.01）. The genotypes of ε2/2 and ε2/3 in ACI group were significantly lower than those in control group（P < 0.05）, and the genotype of ε3/4 in ACI group was higher than that in control group（P < 0.05）. Significantly different levels of the serum Lp-PLA₂ were found between the two group（106.16±38.85 ng/ml, in control group and 146.39±57.90 ng/ml in, ACI group, P < 0.01）. There was no significant difference between the serum level of Lp-PLA₂ in the E4 carriers of the control group and in non-E4 carriers of the ACI group（P>0.05）, while there were significant differences among the other groups（P < 0.01）. The AUC value of serum Lp-PLA₂ was 0.790（95%CI 71.9-86.1）. The critical point of clinical diagnosis is 123.01 ng/ml, the sensitivity was 67.8%, the specificity was 69.6%, and the expression level of Lp-PLA₂ was significant（P < 0.01） for judging the occurrence of ACI. Logistic regression analysis showed that Lp-PLA₂ and ApoE E4 alleles were both risk factors for the diagnosis and treatment of ACI. Conclusion The ApoE E4 allele is a risk factor for acute cerebral infarction and Lp-PLA₂ expression is closely related with ACI patients. The detection of ApoE genotype and serum Lp-PLA₂ is of certain clinical significance in the diagnosis of ACI.更多还原