文章摘要

血清脂蛋白相关磷脂酶A2和高敏C反应蛋白对原发性高血压伴颈动脉粥样硬化斑块的诊断价值

作者: 1张庆考, 1杨久亮, 1王喆
1 解放军总医院京南医疗区新兴桥门诊部，北京 100841
通讯: 张庆考 Email: zqkao@sina.com
DOI: 10.3978/j.issn.2095-6959.2022.11.003

摘要

目的：探究血清脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2，Lp-PLA2)、高敏C反应蛋白(high-sensitivity C-reactive protein，hs-CRP)对原发性高血压伴颈动脉粥样硬化(carotid atherosclerosis，CAS)斑块的诊断价值。方法：选取2020年6月至2021年5月解放军总医院收治的273例原发性高血压患者为研究对象，行颈动脉内膜中层厚度(carotid intima-media thickness，IMT)检查，将有CAS斑块形成者纳入CAS组(n=109)，无CAS斑块形成者纳入对照组(n=164)。收集一般资料及生化指标，用单因素及logistic回归模型分析各项指标与CAS斑块形成的关系，用受试者工作特征(receiver operating characteristic，ROC)曲线分析血清Lp-PLA2、hs-CRP对CAS斑块形成的诊断价值。结果：CAS组收缩压(systolic blood pressure，SBP)、舒张压(diastolic blood pressure，DBP)、空腹血糖(fasting plasma glucose，FPG)、糖化血红蛋白(glycosylated hemoglobin，HbA1c)、血清总胆固醇(total cholesterol，TC)、Lp-PLA2、hs-CRP水平均明显高于对照组(均P<0.05)。Logistic回归分析显示：SBP(OR=2.399)、DBP(OR=1.723)、HbA1c(OR=3.333)、TC(OR=1.874)、Lp-PLA2(OR=1.815)、hs-CRP(OR=1.608)均是CAS斑块形成的独立影响因素(均P<0.05)。ROC曲线分析显示：血清Lp-PLA2、hs-CRP诊断CAS斑块形成的曲线下面积(area under the curve，AUC)分别为0.893、0.684，且以两者联合的诊断效能最大(AUC为0.938，敏感度为87.50%、特异度为93.33%)。结论：血清Lp-PLA2、hs-CRP均与原发性高血压患者CAS斑块形成密切相关，两者联合诊断CAS斑块形成具有较高的效能。
关键词： 脂蛋白相关磷脂酶A2；高敏C反应蛋白；高血压；颈动脉粥样硬化斑块

Value of serum lipoprotein-associated phospholipase A2 and high-sensitivity C-reactive protein in diagnosis of essential hypertension with carotid atherosclerotic plaque

Authors: 1ZHANG Qingkao, 1YANG Jiuliang, 1WANG Zhe
1 Xinxingqiao Outpatient Department, Jingnan Medical District, Chinese PLA General Hospital, Beijing 100841, China

CorrespondingAuthor: ZHANG Qingkao Email: zqkao@sina.com

DOI: 10.3978/j.issn.2095-6959.2022.11.003

Abstract

Objective: To investigate the value of serum lipoprotein-associated phospholipase A2 (Lp-PLA2) and high-sensitivity C-reactive protein (hs-CRP) in diagnosis of essential hypertension with carotid atherosclerotic (CAS) plaque. Methods: A total of 273 patients with essential hypertension admitted to Chinese PLA General Hospital from June 2020 to May 2021 were selected as research subjects, and carotid intima-media thickness (IMT) was examined. Those with CAS plaque formation were included in a CAS group (n=109), and those without CAS plaque formation were included in a control group (n=164). The general data and biochemical indexes were collected, and the relationship between each index and CAS plaque formation was analyzed by univariate logistic regression model. The diagnostic value of serum Lp-PLA2 and hs-CRP for CAS plaque formation was analyzed by receiver operating characteristic (ROC) curve. Results: The levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), serum total cholesterol (TC), Lp-PLA2, and hs-CRP in the CAS group were significantly higher than those in the control group (all P<0.05). Logistic regression analysis showed that SBP (OR=2.399), DBP (OR=1.723), HbA1c (OR=3.333), TC (OR=1.874), Lp-PLA2 (OR=1.815), and hs-CRP (OR=1.608) were all independent influencing factors of CAS plaque formation (all P<0.05). ROC curve analysis showed that the area under the curve (AUC) of serum Lp-PLA2 and hs-CRP in the diagnosis of CAS plaque formation were 0.893 and 0.684, respectively, and the combination of the two had the highest diagnostic efficiency (AUC was 0.938, sensitivity was 87.50%, specificity was 93.33%). Conclusion: Serum Lp-PLA2 and hs-CRP are closely related to CAS plaque formation in patients with essential hypertension. The combination of Lp-PLA2 and hs-CRP has high efficiency in the diagnosis of CAS plaque formation.

Keywords： lipoprotein-associated phospholipase A2; high-sensitivity C-reactive protein; hypertension; carotid atherosclerotic plaque

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