血清UA/Cr、Hcy和ApoA1水平与颈动脉粥样硬化患者斑块稳定性的关系及对继发急性脑梗死的预测价值

The relationship between serum UA/Cr, Hcy and ApoA1 levels and plaque stability in patients with carotid atherosclerosis and the predictive value for secondary acute cerebral infarction

摘要:

目的]探讨血清尿酸(UA)/肌酐(Cr)、同型半胱氨酸(Hcy)、载脂蛋白A1(ApoAl)水平与颈动脉粥样硬化(CAS)患者斑块稳定性的关系及对继发急性脑梗死(ACI)的预测价值。 [方法]选择138例CAS患者作为研究对象,根据斑块的稳定性进一步分为稳定性斑块组和不稳定性斑块组。选择体检健康者作为对照组。采用酶循环法检测Hcy浓度,采用胶乳增强免疫比浊法检测ApoA1浓度,采用尿酸氧化酶法检测UA水平,采用酶法检测Cr水平,并计算UA/Cr比值。比较对照组、稳定性斑块组和不稳定性斑块组的基线资料和实验室指标；采用Spearman相关分析实验室指标与内膜中膜厚度(IMT)的关系；采用Cox回归模型对CAS患者发生ACI进行单因素及多因素分析,并采用ROC曲线评估血清UA/Cr、Hcy和ApoA1水平对其的预测价值。 [结果]在138例CAS患者中,稳定性斑块组74例,不稳定性斑块组64例；继发ACI 46例。对照组42例。与对照组相比,稳定性斑块组和不稳定性斑块组血清ApoA1、高密度脂蛋白胆固醇(HDLC)水平较低,血清UA/Cr、Hcy、低密度脂蛋白胆固醇(LDLC)水平及IMT较高(P＜0.05)。Spearman相关分析显示,斑块组IMT与血清UA/Cr、Hcy水平呈正相关(r＝0.535和r＝0.681,P＜0.05),与ApoA1水平呈负相关(r＝－0.594,P＜0.05)。Cox回归分析显示,不稳定性斑块、高血清UA/Cr和Hcy水平为继发ACI的危险因素,高血清ApoA1水平为继发ACI的保护因素(P＜0.05)。ROC曲线分析显示,血清UA/Cr、Hcy和ApoA1联合预测CAS患者继发ACI的灵敏度和特异度分别为85.45%和82.67%,AUC为0.920,高于UA/Cr、Hcy和ApoA1的单独诊断。 [结论]血清UA/Cr、Hcy水平与CAS患者的斑块形成及稳定性存在显著正相关,ApoA1水平与其存在显著负相关,且三者为CAS患者继发ACI的独立影响因素,联合预测ACI发生的效能较高。

Abstract:

Aim To explore the relationship between serum uric acid (UA)/creatinine (Cr), homocysteine (Hcy), apolipoprotein A1 (ApoAl) levels and plaque stability in patients with carotid atherosclerosis (CAS) and the predictive value for secondary acute cerebral infarction (ACI). Methods 138 patients with CAS were selected as the research subjects and further divided into stable plaque group and unstable plaque group based on the stability of plaques. Heathy individuals undergoing physical examinations were selected as the control group. Enzyme cycling method was used to detect Hcy level, latex enhanced immunoturbidimetry method was used to detect ApoA1 level, uricase method was used to detect UA level, enzyme method was used to detect Cr level, and UA/Cr ratio was calculated. Baseline data and laboratory indicators in the no plaque group, stable plaque group and unstable plaque group were compared. The relationship between laboratory indicators and intima-media thickness (IMT) was analyzed using Spearman correlation analysis. Cox regression model was used for univariate and multivariate analysis of secondary ACI in patients with CAS, and ROC curve was used to evaluate the predictive value of serum UA/Cr, Hcy and ApoA1 levels for it. Results Among 138 patients with CAS, there were 74 cases in the stable plaque group and 64 cases in the unstable plaque group; there were 46 cases of secondary ACI. There were 42 cases in the control group. Compared with the control group, the stable plaque group and unstable plaque group had lower levels of serum ApoA1 and high density lipoprotein cholesterol (HDLC), and higher levels of serum UA/Cr, Hcy, low density lipoprotein cholesterol (LDLC) and IMT (P＜0.05). Spearman correlation analysis showed that IMT in the plaque group was positively correlated with serum UA/Cr and Hcy levels (r＝0.535 and r＝0.681, P＜0.05), and negatively correlated with ApoA1 levels (r＝－0.594, P＜0.05). Cox regression analysis showed that unstable plaques, high serum UA/Cr and Hcy levels were risk factors for secondary ACI, while high serum ApoA1 levels were protective factors for secondary ACI (P＜0.05). ROC curve analysis showed that the sensitivity and specificity of combining serum UA/Cr, Hcy and ApoA1 for predicting secondary ACI in the CAS patients were 85.45% and 82.67%, respectively, with an AUC of 0.920, which was higher than the individual diagnosis of UA/Cr, Hcy and ApoA1. Conclusions The levels of serum UA/Cr and Hcy are significantly positively correlated with plaque formation and stability in the CAS patients, while ApoA1 is significantly negatively correlated with them. These three factors are independent influencing factors for secondary ACI in the CAS patients, and their combined prediction of ACI has a higher efficacy.