RBP4、LDLC/Alb和MHR与颈动脉粥样硬化人群斑块稳定性的关系及其对缺血性脑卒中的预测价值

Correlation between RBP4, LDLC/Alb, MHR and plaque stability in carotid atherosclerosis population and their predictive value for acute ischemic stroke

摘要:

目的]分析血清视黄醇结合蛋白4(RBP4)、低密度脂蛋白胆固醇/白蛋白比值(LDLC/Alb)、单核细胞/高密度脂蛋白比值(MHR)与颈动脉粥样硬化人群斑块稳定性的相关性及其对缺血性脑卒中(AIS)的预测价值。 [方法]选取2021年9月—2023年1月本院收治的197例无症状颈动脉粥样硬化患者进行前瞻性队列研究,根据12个月内是否发生AIS分为发生组和未发生组。比较两组就诊时基线资料、颈部超声检测结果和血清RBP4、LDLC/Alb、MHR水平,以Spearman/Pearson相关分析和受试者工作特征(ROC)曲线分析RBP4、LDLC/Alb和MHR与颈动脉粥样硬化及斑块稳定性的相关性,以及其预测颈动脉粥样硬化人群AIS的价值,通过Hosmer-Lemeshow拟合优度检验来评价血清RBP4、LDLC/Alb和MHR三者联合预测颈动脉粥样硬化人群AIS的校准能力。 [结果]发生组颈动脉内膜中膜厚度(IMT)高于未发生组,软斑块、混合型斑块多于未发生组(P＜0.05)；发生组血清RBP4、LDLC/Alb和MHR水平高于未发生组(P＜0.05)；相关性分析显示,血清RBP4、LDLC/Alb和MHR水平与IMT(r＝0.803、0.740、0.710)和斑块性质(r＝0.736、0.685、0.703)呈正相关(P＜0.001)；ROC曲线分析显示血清RBP4、LDLC/Alb和MHR预测颈动脉粥样硬化人群AIS的AUC分别为0.796、0.821和0.828,其中MHR的AUC最大；血清RBP4、LDLC/Alb和MHR联合预测的AUC为0.936,大于MHR单独预测的AUC(Z＝2.978,P＜0.05),预测灵敏度为88.24%,特异度为87.40%；Hosmer-Lemeshow拟合优度检验显示,血清RBP4、LDLC/Alb和MHR联合预测颈动脉粥样硬化人群AIS与实际观测值之间的差异无显著性(P＞0.05),预测模型有较好的校准能力。 [结论]血清RBP4、LDLC/Alb和MHR与颈动脉粥样硬化及斑块稳定性呈正相关,可预测AIS的发生,三者联合检测可作为早期识别潜在AIS高风险人群的一个方法,为颈动脉粥样硬化人群AIS的防治提供一个新的、可量化的指导方案。

Abstract:

Aim To analyze the correlation between serum retinol-binding protein 4 (RBP4), low density lipoprotein cholesterol to albumin ratio (LDLC/Alb), monocyte to high density lipoprotein ratio (MHR) and plaque stability in carotid atherosclerosis population and their predictive value for acute ischemic stroke (AIS). Methods A total of 197 patients with asymptomatic carotid atherosclerosis admitted to our hospital from September 2021 to January 2023 were selected for a prospective cohort study, and they were categorized into occurred group and non-occurred group according to whether AIS occurred within 12 months. Baseline information at time of visit, results of the cervical ultrasonography and serum RBP4, LDLC/Alb, MHR levels were compared between the two groups. Spearman/Pearson and receiver operating characteristic (ROC) curve were used to analyze the correlation of RBP4, LDLC/Alb and MHR with carotid atherosclerosis and plaque stability, and the value of predicting AIS in carotid atherosclerosis population. Hosmer-Lemeshow goodness of fit test was used to evaluate the calibration ability of serum RBP4, LDLC/Alb and MHR to jointly predict AIS in carotid atherosclerosis population. Results The carotid intima-media thickness (IMT) was higher in occurred group than that in non-occurred group. There were more soft plaques and mixed plaques in occurred group than in non-occurred group (P＜0.05). Serum levels of RBP4, LDLC/Alb and MHR were higher in occurred group than those in non-occurred group (P＜0.05). The correlation analysis showed that the levels of serum RBP4, LDLC/Alb and MHR were positively correlated with IMT (r＝0.3,0.0,0.710) and plaque properties (r＝0.6,0.5,0.703) (P＜0.001). ROC curve analysis showed that the AUC of serum RBP4, LDLC/Alb and MHR in predicting AIS in carotid atherosclerosis population was 0.6,0.821 and 0.828, respectively, and the AUC of MHR was the largest; the AUC of the combination of serum RBP4, LDLC/Alb and MHR was 0.936, which was higher than that of MHR (Z＝2.978, P＜0.05), the predictive sensitivity and specificity were 88.24% and 87.40%. Hosmer-Lemeshow goodness of fit test showed that there was no significant difference between serum RBP4, LDLC/Alb and MHR in predicting AIS and the actual observation value in carotid atherosclerosis population (P＞0.05), and the prediction model had good calibration ability. Conclusion Serum RBP4, LDLC/Alb, and MHR are positively correlated with carotid atherosclerosis and plaque stability, and can predict the occurrence of AIS. Combined detection of the three can be used as a method for early identification of potential high-risk populations for AIS, providing a new, quantifiable guidance scheme for the prevention and treatment of AIS in carotid atherosclerotic population.