【摘要】 目的探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)与老年急性脑梗死病人继发血管性痴呆(VD)的相关性。方法回顾性分析我院2017～2018年收治的113例急性脑梗死病人的临床资料,其中未合并VD者61例为未合并VD组,合并VD者52例为合并VD组。比较2组相关临床资料,采用Logistic回归模型确定VD发生的危险因素;并进一步探讨Lp-PLA2与VD病情严重程度的相关性及诊断界值。结果合并VD组年龄、饮酒比例、小学及以下文化程度比例、梗死面积、hs-CRP、Hcy及Lp-PLA2水平均显著高于未合并VD组(P<0.05)。Logistic回归分析显示,年龄、受教育程度、hs-CRP、Hcy及Lp-PLA2水平是急性脑梗死继发VD的独立影响因素(P<0.05)。Pearson相关性分析显示,Lp-PLA2和MMSE评分、MoCA评分间呈负相关(r=-0.49、-0.40,P=<0.01)。Lp-PLA2用于急性脑梗死合并VD诊断的AUC为0.81,约登指数为0.50,诊断界值为>165.71 ng/mL; Lp-PLA2用于急性脑梗死非痴呆性认知障碍诊断的AUC为0.63,约登指数为0.27,诊断界值为>122.09 ng/mL。结论急性脑梗死病人的年龄、受教育程度、hs-CRP、Hcy及Lp-PLA2水平与继发VD密切相关;同时Lp-PLA2水平升高还可能导致VD病情加重。更多还原

【Abstract】 Objective To investigate the relationship of lipoprotein-associated phospholipase A2( Lp-PLA2) with vascular dementia( VD) secondary to acute cerebral infarction in the elderly.Methods The clinical data of 113 patients with acute cerebral infarction from January 2017 to December2018 were retrospectively analyzed,and the patients were divided into non-VD group( 61 cases) and VD group( 52 cases). The clinical data were compared between the two groups,and the risk factors of VD were analyzed by Logistic regression model. The correlation between Lp-PLA2 and the severity of VD and the diagnostic threshold were further explored. Results The age,alcohol consumption,education level,infarct size,high-sensitivity C-reactive protein( hs-CRP),homocysteine( Hcy) and Lp-PLA2 levels in VD group were significantly higher than those in non-VD group( P < 0. 05). Logistic regression analysis showed that age,education level,hs-CRP,Hcy and Lp-PLA2 levels were independent influence factors of VD secondary to acute cerebral infarction( P < 0. 05). Pearson correlation analysis showed that the level of Lp-PLA2 was negatively correlated with MMSE score and Mo CA score( r =-0. 49,-0. 40,P<0. 01). Lp-PLA2 was used to diagnose VD with AUC = 0. 81,Yoden index = 0. 50 and diagnostic threshold value >165. 71 ng/mL; Lp-PLA2 was used to diagnose non-dementia cognitive impairment with AUC = 0. 63,Yoden index = 0. 27 and diagnostic threshold value > 122. 09 ng/mL. Conclusions Age,education level,hs-CRP,Hcy and Lp-PLA2 levels of patients with acute cerebral infarction are closely related to secondary VD,and elevated level of Lp-PLA2 may also lead to aggravation of VD condition.更多还原