Correlations between carotid atherosclerotic plaque characteristics and plasma plasma positive pentameric protein 3, hypersensitive C-reactive protein in patients with acute cerebral infarction
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摘要:目的 探讨急性脑梗死(ACI)患者颈动脉粥样硬化斑块特性与血浆正五聚蛋白3(PTX3)、超敏C反应蛋白(hs-CRP)的相关性。方法 将120例ACI患者根据颈动脉彩超检查结果分为不稳定斑块组(USP组，n=40)、稳定斑块组(SP组，n=42)和无斑块组(NP组，n=38)。另外选取同时期40例健康体检者为对照组。检测所有研究对象血浆PTX3、hs-CRP水平，并行颈动脉彩超检查，测量颈动脉内膜中层厚度(CIMT)。比较各组血浆PTX3、hs-CRP水平和CIMT。采用Pearson相关性分析探讨血浆PTX3、hs-CRP水平与CIMT的相关性，多因素Logistics回归分析探讨ACI发病和ACI患者颈动脉粥样硬化斑块发生的相关因素。结果 USP组、SP组、NP组血浆PTX3、hs-CRP水平及CIMT高于对照组，差异有统计学意义(P < 0.05)；血浆PTX3、hs-CRP水平在USP组、SP组、NP组均呈逐渐降低趋势，差异有统计学意义(P < 0.05)。Pearson相关性分析显示，血浆PTX3、hs-CRP水平与CIMT呈正相关(P < 0.05)；多因素Logistics回归分析显示，PTX3和hs-CRP为ACI发病和ACI患者颈动脉不稳定斑块的独立影响因素(P < 0.05)。结论 ACI患者血浆PTX3、hs-CRP水平明显提升，且与颈动脉粥样硬化斑块稳定性有密切关系，因此早期监测有助于预测ACI发生。Abstract:Objective To investigate the correlations between carotid atherosclerotic plaque characteristics and plasma positive pentameric protein 3 (PTX3), hypersensitive C-reactive protein (hs-CRP) in patients with acute cerebral infarction (ACI).Methods A total of 120 patients with ACI were selected and divided into unstable plaque group (USP group, n=40) and stable plaque group (SP group, n=42), non-plaque group (NP group, n=38) according to results of carotid color Doppler ultrasound examination. Another 40 healthy people with physical examinations at the same period were selected as the control group. Plasma PTX3 and hs-CRP levels of all subjects were detected, and carotid artery color ultrasound was performed to measure carotid intima-media thickness (CIMT). Plasma levels of PTX3, hs-CRP and CIMT were compared. Pearson correlation analysis was used to explore the correlations between plasma PTX3, hs-CRP levels and CIMT. Multivariate Logistic regression analysis was used to explore the factors related to the incidence of ACI and the occurrence of carotid atherosclastic plaque in ACI patients.Results The levels of PTX3, hs-CRP and CIMT in the USP, SP, and NP groups were significantly higher than those in the control group (P < 0.05). The levels of PTX3, hs-CRP in the USP, SP, and NP groups were gradually decreased (P < 0.05); Pearson correlation analysis showed that plasma PTX3 and hs-CRP levels were positively correlated with CIMT (P < 0.05); multivariate Logistic regression analysis showed that PTX3 and hs-CRP were independent risk factors for occurrence of ACI and instable plaque in the carotid artery in ACI patients (P < 0.05).Conclusion The levels of plasma PTX3 and hs-CRP in ACI patients are significantly increased, and they are closely related to the stability of carotid atherosclerotic plaque. Early monitoring can help predict the occurrence of ACI.
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表 1 4组一般生化指标比较(x±s)
指标 USP组(n=40) SP组(n=42) NP组(n=38) 对照组(n=40) Hcy/(μmol/L) 21.28±9.21* 18.29±8.42* 17.14±6.53* 13.41±6.07 NEUT/(×109/L) 4.78±1.92* 4.61±1.99* 4.48±1.82* 3.61±1.28 WBC/(×109/L) 7.23±1.97* 7.15±2.17* 6.78±1.64* 6.06±1.67 LP(a)/(mg/L) 407.57±304.26* 358.97±310.73* 331.74±338.32* 198.54±184.61 HDL-C/(mmol/L) 1.28±0.26 1.29±0.31 1.28±0.41 1.38±0.89 LDL-C/(mmol/L) 2.68±0.68 2.53±0.79 2.45±0.53 2.33±0.82 TC/(mmol/L) 4.36±0.78 4.28±0.72 4.20±1.80 4.07±0.97 TG/(mmol/L) 1.68±0.78 1.56±0.83 1.62±0.76 1.57±0.73 Hcy: 同型半胱氨酸; NEUT: 中性粒细胞计数; WBC: 白细胞计数; LP(a): 脂蛋白(a); HDL-C: 高密度脂蛋白胆固醇;
LDL-C: 低密度脂蛋白胆固醇; TC: 总胆固醇; TG: 三酰甘油。与对照组比较, * P＜0.05。
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表 2 4组血浆PTX3、hs-CRP水平及CIMT比较(x±s)
组别 n PTX3/(ng/mL) hs-CRP/(mg/L) CIMT/mm USP组 42 13.20±0.78 *#△ 23.93±5.78*#△ 1.65±0.15*#△ SP组 40 10.68±0.87 *# 14.54±4.07*# 1.54±0.12 *# NP组 38 9.52±1.07* 7.32±2.77* 1.22±0.03* 对照组 40 6.92±0.61 2.88±1.92 0.90±0.02 PTX3: 正五聚蛋白3; hs-CRP: 超敏C反应蛋白; CIMT: 颈动脉内膜中层厚度。
与对照组比较, * P＜0.05; 与NP组比较, #P＜0.05; 与SP组比较, △P＜0.05。
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表 3 ACI相关危险因素的多因素Logistics回归分析
因素 β SE P OR 95% CI Hcy 0.098 0.040 0.013 1.104 1.023~1.128 NEUT 0.187 0.328 0.418 1.425 0.632~4.168 WBC -0.328 0.568 0.422 0.741 0.457~1.642 LP(a) 0.062 0.017 0.926 1.054 1.003~1.354 PTX3 1.254 0.342 ＜0.001 3.502 1.782~6.873 hs-CRP 0.272 0.116 0.021 1.312 1.043~1.648 Hcy: 同型半胱氨酸; NEUT: 中性粒细胞计数; WBC: 白细胞计数; LP(a): 脂蛋白(a);
hs-CRP: 超敏C反应蛋白; PTX3: 正五聚蛋白3。
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表 4 ACI患者颈动脉粥样硬化斑块相关因素的多因素Logistics回归分析
因素 β SE P OR 95%CI Hcy 0.052 0.036 0.151 1.053 0.981~1.140 NEUT 0.284 0.462 0.538 1.330 0.538~3.278 WBC -0.456 0.452 0.325 0.636 0.259~1.554 LP(a) 0.058 0.013 0.813 1.005 0.998~1.002 PTX3 1.173 0.450 0.013 3.232 1.289~8.083 hs-CRP 0.235 0.272 0.024 1.246 0.979~2.586 Hcy: 同型半胱氨酸; NEUT: 中性粒细胞计数; WBC: 白细胞计数; LP(a): 脂蛋白(a);
hs-CRP: 超敏C反应蛋白; PTX3: 正五聚蛋白3。
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