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急性脑梗死(acute cerebral infarction,ACI)是中老年人常见疾病,随着社会老龄化的逐步加剧,ACI发病率、病残率、病死率逐渐增高,严重威胁病人生命安全,降低病人生活质量[1]。颈动脉狭窄是ACI的危险因素之一,动脉粥样硬化斑块不稳定引起的破裂、糜烂、脱落导致血管堵塞是ACI的主要发病机制[2-3]。过度表达炎性细胞因子在ACI发生发展中起重要作用[4]。超敏C反应蛋白(hypersensitive C reactive protein,hs-CRP)[5]、细胞间黏附分子(intercellular cell adhesion molecule,ICAM-1)均参与动脉粥样硬化斑块形成过程[6]。而核细胞趋化蛋白-1(monocyte chemotaxis protein-1,MCP-1)是动脉粥样硬化斑块炎症反应和单核细胞募集的标志物[7]。目前ICAM-1、hs-CRP、MCP-1与ACI病人颈动脉斑块性质是否存在关联尚不完全明确,ICAM-1、hs-CRP、MCP-1能否为颈动脉斑块性质鉴别提供有效信息亦尚不清楚,鉴于此,本研究选择105例ACI病人检测血清ICAM-1、hs-CRP、MCP-1水平和颈动脉斑块性质,分析其间相关性,旨在为临床诊疗提供理论依据。
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易损斑块组合并高血压比例、合并高血脂比例、合并糖尿病比例、收缩压、吸烟史比例、TC、LDL-C、IMT、血清ICAM-1、hs-CRP及MCP-1水平均高于稳定斑块组(P < 0.01)。2组性别、年龄、体质量、舒张压、冠心病比例、饮酒史比例、ACI家族史比例、TG、HDL-C差异均无统计学意义(P>0.05)(见表 1)。
项目 易损斑块组(n=66) 稳定斑块组(n=39) t P 性别 男 40 21 0.46* >0.05 女 26 18 年龄/岁 61.21±5.49 60.13±4.18 1.06 >0.05 体质量/(kg/m2) 26.13±2.31 25.50±1.85 1.49 >0.05 收缩压/mmHg 142.13±10.49 132.16±9.56 4.86 < 0.01 舒张压/mmHg 77.14±6.34 76.23±5.65 0.74 >0.05 高血压 49 18 8.38* < 0.01 糖尿病 59 15 30.56* < 0.01 高血脂 51 20 7.56* < 0.01 冠心病 16 10 0.03* >0.05 吸烟史 49 21 4.59* < 0.05 饮酒史 29 16 0.09* >0.05 ACI家族史 9(13.64) 3(7.69) 0.86* >0.05 TC/(mmol/L) 5.82±0.35 5.17±0.39 4.64 < 0.01 TG/(mmol/L) 1.69±0.81 1.65±0.71 0.26 >0.05 HDL-C/(mmol/L) 2.12±0.43 2.01±0.38 1.32 >0.05 LDL-C/(mmol/L) 3.52±1.31 2.39±1.05 4.58 < 0.01 IMT/mm 1.49±0.72 1.13±0.35 2.92 < 0.01 ICAM-1/(ng/mL) 693.26±35.16 420.63±24.16 42.78 < 0.01 hs-CRP/(mg/L) 15.65±3.13 6.68±1.64 16.58 < 0.01 MCP-1/(pg/mL) 41.27±6.96 25.85±4.49 12.38 < 0.01 *示χ2值 表 1 基线资料、血清ICAM-1、hs-CRP及MCP-1水平比较(x±s)
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血清ICAM-1、hs-CRP、MCP-1水平在0.9 mm < IMT≤1.2 mm组、1.2 mm < IMT≤1.4 mm组、IMT>1.4mm组依次升高(P < 0.05~ P < 0.01)(见表 2)。Pearson相关性分析显示:ICAM-1、hs-CRP、MCP-1与ACI病人IMT呈正相关(r=0.495、0.585、0.498,P < 0.05)(见图 2)。
IMT n ICAM-1/(ng/ml) hs-CRP/(mg/L) MCP-1/(pg/mL) 0.9 mm < IMT≤1.2 mm 19 413.61±19.56 8.46±2.02 24.58±3.12 1.2 mm < IMT≤1.4 mm 37 541.43±23.07** 10.34±2.64* 32.16±6.53** IMT>1.4 mm 49 699.35±36.48**△△ 15.31±3.74**△△ 42.35±7.59**△△ F — 716.83 44.37 56.72 P — < 0.01 < 0.01 < 0.01 MS组内 — 881.615 9.762 43.877 q检验:与0.9 mm < IMT≤1.2 mm组比较*P < 0.05,** P < 0.01;与1.2 mm < IMT≤1.4 mm组比较△△P < 0.01 表 2 不同IMT值AIC病人血清ICAM-1、hs-CRP及MCP-1水平比较(x±s)
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以ACI病人颈动脉斑块性质(1=不稳性,0=稳定)为因变量,以高血压(赋值:1=是,0=否)、高血脂(赋值:1=是,0=否)、糖尿病(赋值:1=是,0=否)、收缩压(连续性变量)、吸烟史(赋值:1=是,0=否)、TC(连续性变量)、LDL-C(连续性变量)、IMT(连续性变量)、ICAM-1(连续性变量)、hs-CRP(连续性变量)、MCP-1(连续性变量)为自变量,建立logistic回归模型。校正了年龄、性别混杂因素,合并糖尿病、LDL-C、ICAM-1、hs-CRP、MCP-1均是ACI病人颈动脉粥样硬化斑块不稳定的危险因素(P < 0.05~P < 0.01)(见表 3)。
因素 B SE Waldχ2 OR(95%CI) P 合并糖尿病 0.623 0.203 9.42 1.865(1.325~6.592) < 0.05 LDL-C(高) 0.659 0.211 9.76 1.933(1.365~8.642) < 0.01 ICAM-1(高) 0.995 0.224 19.73 2.705(1.065~15.926) < 0.01 hs-CRP(高) 0.832 0.217 14.70 2.298(1.324~12.037) < 0.01 MCP-1(高) 0.695 0.196 12.57 2.004(1.245~10.235) < 0.01 表 3 影响ACI病人颈动脉粥样硬化斑块不稳定的logistic回归分析
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血清ICAM-1、hs-CRP、MCP-1、ICAM-1+hs-CRP+MCP-1水平预测ACI病人颈动脉粥样硬化斑块不稳定的曲线下面积(AUC)分别为0.722(95%CI:0.615~0.829,P < 0.01)、0.753(95%CI:0.655~0.852,P < 0.01)、0.646(95%CI:0.537~0.755,P < 0.05)、0.852(95%CI:0.761~0.942,P < 0.01)(见图 3)。ICAM-1+hs-CRP+MCP-1高于单独ICAM-1、hs-CRP、MCP-1预测价值(z=2.35、2.01、2.99,P < 0.05),ICAM-1、hs-CRP、MCP-1、ICAM-1+hs-CRP+MCP-1水平预测ACI病人颈动脉粥样硬化斑块不稳定的界值、灵敏度、特异度、阳性预测值、阴性预测值见表 4。
指标 截断值 灵敏度/% 特异度/% 阳性预测值/% 阴性预测值/% ICAM-1 635.26 ng/mL 69.23 74.24 79.41 80.33 hs-CRP 13.06 mg/L 79.49 68.18 60.78 84.91 MCP-1 37.46 pg/mL 66.67 65.15 53.06 76.79 联合 — 89.74 89.39 83.33 93.65 表 4 ICAM-1、hs-CRP、MCP-1、ICAM-1+hs-CRP+MCP-1预测ACI病人颈动脉粥样硬化斑块不稳定的效能
血清ICAM-1、hs-CRP及MCP-1与急性脑梗死病人颈动脉斑块性质的相关性
Correlation between serum ICAM-1, hs-CRP and MCP-1 and carotid plaque in patients with acute cerebral infarction
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摘要:
目的探讨血清细胞间黏附分子(ICAM-1)、超敏C反应蛋白(hs-CRP)、单核细胞趋化蛋白-1(MCP-1)与急性脑梗死(ACI)病人颈动脉斑块性质的相关性。 方法选择105例ACI病人作为研究对象,收集病人临床资料,酶联免疫法测定检测血清hs-CRP、MCP-1水平,双抗体夹心酶联免疫法检测血清ICAM-1水平,颈动脉超声检测颈动脉内-中膜厚度(IMT)和颈动脉斑块性质,根据IMT值将病人分为0.9 mm < IMT ≤ 1.2 mm、1.2 mm < IMT ≤ 1.4 mm、IMT>1.4 mm 3个亚组,根据斑块性质将病人分为稳定性斑块组(39例)和易损斑块组(66例)。Pearson相关分析分析血清ICAM-1、hs-CRP、MCP-1水平与IMT相关性。多元logistic回归分析分析影响ACI颈动脉粥样硬化斑块不稳定的危险因素,受试者工作特征曲线(ROC)分析血清ICAM-1、hs-CRP、MCP-1水平预测ACI病人颈动脉粥样硬化斑块不稳定的价值。 结果易损斑块组血清ICAM-1、hs-CRP、MCP-1水平均高于稳定性斑块组(P < 0.01)。血清ICAM-1、hs-CRP、MCP-1水平在0.9 mm < IMT ≤ 1.2 mm组、1.2 mm < IMT ≤ 1.4 mm组、IMT>1.4 mm组依次升高(P < 0.05~P < 0.01)。Pearson相关分析结果显示血清ICAM-1、hs-CRP、MCP-1水平与IMT呈正相关(r=0.495、0.585、0.498,P < 0.05)。多元logistic回归分析结果显示高水平ICAM-1、hs-CRP、MCP-1及LDL-C、合并糖尿病是ACI病人颈动脉斑块性质不稳定的危险因素(P < 0.01)。ROC分析结果显示血清ICAM-1、hs-CRP、MCP-1及三者联合预测ACI病人颈动脉粥样硬化斑块不稳定的曲线下面积分别为0.722、0.753、0.646、0.852,灵敏度分别为69.23%、79.49%、66.67%、89.74%,特异度分别为74.24%、68.18%、65.15%、89.39%。 结论血清ICAM-1、hs-CRP、MCP-1水平与ACI病人颈动脉粥样硬化斑块性质有关,可能作为颈动脉斑块不稳定的预测因子。 -
关键词:
- 急性脑梗死 /
- 颈动脉斑块 /
- 细胞间黏附分子-1 /
- 超敏C反应蛋白 /
- 单核细胞趋化蛋白-1
Abstract:ObjectiveTo investigate the correlations between serum intercellular adhesion molecule-1(ICAM-1), hypersensitive C reactive protein(hs-CRP), monocyte chemoattractant protein-1(MCP-1) and carotid artery plaque in patients with acute cerebral infarction(ACI). MethodsOne hundred and five ACI patients were admitted, the patients' clinical data were collected, the levels of serum hs-CRP and ICAM-1 were detected by ELISA and serum MCP-1 level was detected by double antibody sandwich ELISA, and the carotid intima-media thickness(IMT) and the characteristics of carotid artery plaque were measured by carotid ultrasound.The patients were subdivided into 0.9 mm < IMT ≤ 1.2 mm group, 1.2 mm < IMT ≤ 1.4 mm group, IMT>1.4 mm group, and also divided into the stability plaque group(39 cases) and vulnerable plaque group(66 cases) according to the characteristics of the plaques.The correlations between serum hs-CRP, ICAM-1, MCP-1 and IMT were analyzed by Pearson correlation analysis.The risk factors influencing the ACI carotid atherosclerotic plaque instability were analyzed by multiple logistic regression analysis, and the value of serum hs-CRP, ICAM-1, MCP-1 levels in predicting the carotid atherosclerotic plaque instability in ACI patients were analyzed by the receiver operating characteristic(ROC) curve. ResultsThe levels of serum hs-CRP, ICAM-1 and MCP-1 in vulnerable plaques group were higher than those in stability plaque group(P < 0.01).The levels of serum hs-CRP, ICAM-1 and MCP-1 were increased successively in the 0.9 mm < IMT ≤ 1.2 mm group, 1.2 mm < IMT ≤ 1.4 mm group, and IMT>1.4 mm group(P < 0.05 to P < 0.01).Pearson correlation analysis showed that serum hs-CRP, ICAM-1 and MCP-1 levels were positively correlated with IMT(r=0.495, 0.585, 0.498, P < 0.05).Multiple logistic regression analysis showed that the high levels of ICAM-1, hs-CRP, MCP-1, LDL-C and diabetes mellitus were the risk factors for carotid plaque instability in ACI patients(P < 0.01).ROC analysis showed that serum hs-CRP, ICAM-1 and MCP-1 levels and the combinations of the three factors which predicted the area under the curve(AUC) of carotid atherosclerotic plaque instability in ACI patients were 0.722, 0.753, 0.646 and 0.852, respectively.The sensitivity was 69.23%, 79.49%, 66.67% and 89.74%, and the specificity was 74.24%, 68.18%, 65.15% and 89.39%, respectively. ConclusionsSerum ICAM-1, hs-CRP and MCP-1 levels are related to the characteristics of carotid atherosclerotic plaque in ACI patients, which may be used as the predictors of carotid plaque instability. -
表 1 基线资料、血清ICAM-1、hs-CRP及MCP-1水平比较(x±s)
项目 易损斑块组(n=66) 稳定斑块组(n=39) t P 性别 男 40 21 0.46* >0.05 女 26 18 年龄/岁 61.21±5.49 60.13±4.18 1.06 >0.05 体质量/(kg/m2) 26.13±2.31 25.50±1.85 1.49 >0.05 收缩压/mmHg 142.13±10.49 132.16±9.56 4.86 < 0.01 舒张压/mmHg 77.14±6.34 76.23±5.65 0.74 >0.05 高血压 49 18 8.38* < 0.01 糖尿病 59 15 30.56* < 0.01 高血脂 51 20 7.56* < 0.01 冠心病 16 10 0.03* >0.05 吸烟史 49 21 4.59* < 0.05 饮酒史 29 16 0.09* >0.05 ACI家族史 9(13.64) 3(7.69) 0.86* >0.05 TC/(mmol/L) 5.82±0.35 5.17±0.39 4.64 < 0.01 TG/(mmol/L) 1.69±0.81 1.65±0.71 0.26 >0.05 HDL-C/(mmol/L) 2.12±0.43 2.01±0.38 1.32 >0.05 LDL-C/(mmol/L) 3.52±1.31 2.39±1.05 4.58 < 0.01 IMT/mm 1.49±0.72 1.13±0.35 2.92 < 0.01 ICAM-1/(ng/mL) 693.26±35.16 420.63±24.16 42.78 < 0.01 hs-CRP/(mg/L) 15.65±3.13 6.68±1.64 16.58 < 0.01 MCP-1/(pg/mL) 41.27±6.96 25.85±4.49 12.38 < 0.01 *示χ2值 表 2 不同IMT值AIC病人血清ICAM-1、hs-CRP及MCP-1水平比较(x±s)
IMT n ICAM-1/(ng/ml) hs-CRP/(mg/L) MCP-1/(pg/mL) 0.9 mm < IMT≤1.2 mm 19 413.61±19.56 8.46±2.02 24.58±3.12 1.2 mm < IMT≤1.4 mm 37 541.43±23.07** 10.34±2.64* 32.16±6.53** IMT>1.4 mm 49 699.35±36.48**△△ 15.31±3.74**△△ 42.35±7.59**△△ F — 716.83 44.37 56.72 P — < 0.01 < 0.01 < 0.01 MS组内 — 881.615 9.762 43.877 q检验:与0.9 mm < IMT≤1.2 mm组比较*P < 0.05,** P < 0.01;与1.2 mm < IMT≤1.4 mm组比较△△P < 0.01 表 3 影响ACI病人颈动脉粥样硬化斑块不稳定的logistic回归分析
因素 B SE Waldχ2 OR(95%CI) P 合并糖尿病 0.623 0.203 9.42 1.865(1.325~6.592) < 0.05 LDL-C(高) 0.659 0.211 9.76 1.933(1.365~8.642) < 0.01 ICAM-1(高) 0.995 0.224 19.73 2.705(1.065~15.926) < 0.01 hs-CRP(高) 0.832 0.217 14.70 2.298(1.324~12.037) < 0.01 MCP-1(高) 0.695 0.196 12.57 2.004(1.245~10.235) < 0.01 表 4 ICAM-1、hs-CRP、MCP-1、ICAM-1+hs-CRP+MCP-1预测ACI病人颈动脉粥样硬化斑块不稳定的效能
指标 截断值 灵敏度/% 特异度/% 阳性预测值/% 阴性预测值/% ICAM-1 635.26 ng/mL 69.23 74.24 79.41 80.33 hs-CRP 13.06 mg/L 79.49 68.18 60.78 84.91 MCP-1 37.46 pg/mL 66.67 65.15 53.06 76.79 联合 — 89.74 89.39 83.33 93.65 -
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