Lipoprotein-associated phospholipase A2 predicts early neurological deterioration in patients with lacunar infarction / 中国脑血管病杂志

ABSTRACT

Objective To study the predictive value of lipoprotein-associated phospholipase A2 ( Lp-PLA2)for early neurological deterioration (END) in patients with lacunar infarction. Methods Between January 2016 and July 2018,281 consecutive patients with first-ever acute lacunar infarction admitted to the Department of Neurology, the Second People's Hospital of Lianyungang were enrolled retrospectively. They were divided into END group (n = 75 ) and non-END group ( n = 206) depending on whether END occurred or not. The general data ( age, sex, body mass index,past medical history) ,clinical data (National Institute of Health stroke scale [ NIHSS score] ) , onset to admission time,imaging data (white matter lesion score,cerebral microhemorrhage score and branch atherosclerosis) , treatment methods and laboratory findings such as neutrophil to lymphocyte ratio, total cholesterol,low- density lipoprotein cholesterol, fasting blood glucose, hypersensitive C-reactive protein, homocysteine, and Lp-PLA2 were compared in patients between the two groups. Immunoturbidimetry was used to determine the level of Lp-PLA2 in blood. SPSS 22. 0 software was used to analyze and process the data. Multivariate logistic regression was used to analyze the risk factors for affecting the occurrence of END in patients with lacunar cerebral infarction. Receiver operating characteristic (ROC) curve was used to analyze the value of Lp-PLA2 in predicting the occurrence of END in lacunar infarction. Results Univariate analysis showed that NLR (2. 5 ± 0. 5 vs. 2. 3 ± 0. 5, t = 2. 996) , low-density lipoprotein cholesterol (2. 6 ± 0. 8 mmol/L vs. 2. 3 ± 0. 7 mmol/L, t = 3. 056), NIHSS score on admission ( 3.4 ± 1.5 vs. 3.0 ± 1.4, l = 2. 080), and the proportion of patients with branch atherosclerosis (21. 3% [ 16/75] vs. 7. 3% [ 15/206] #=1 1-061) in the END group were higher than those in the non-END group (240 ± 26 jxg/L vs. 180 ±23 p,g/L, I = 9. 032) ,and the difference was statistically significant (all P <0. 05). Multivariate logistic regression analysis showed that the increased level of NLR (0/,3.927,95% CI 2.918 -5.016,P = 0.020),Lp-PLA2 (OR, 1.026,95% 67 1.019-1.034, P <0.01), low-density lipoprotein cholesterol (OR, 2.715,95% CI 2.193 -3.273, P =0.025) , NIHSS score on admission (OR,2. 831 ,95% CI 2.412 -3. 197, P = 0.028) , and branch atherosclerosis ( OR,4. 552 ,95% CI 2. 934 -7. 017 , P = 0. 002) were the independent risk factors for lacunar infarction occurring END. Receiver operating characteristic ( ROC) curve analysis showed that the area under the curve of Lp-PLA2 predicting END was 0. 799 (95% CI 0. 728 -0. 833 ,P< 0. 01 ) ;the optimal cut-off value was 189 jtg/L, the sensitivity for predicting END was 92. 3% ,and the specificity was 55. 4%. Conclusion The increased level of serum I.p-PLA2 is an independent risk factor for lacunar infarction occurring END,and it has certain predictive value for END.