Abstract: Objective To explore the prognosis value of lipoprotein-associated phospholipase A2(Lp-PLA2) for risk of atherothrombosis stroke(AT).Methods A retrospective case-control study was used, and the serum Lp-PLA2 level was assessed in 80 patients which were collected by Trial of Org 10172 in Acute Stroke Treatment(TOAST) criteria for AT and 80 controls without history of relevant vascular diseases. Traditional risk factors for AT and risk factors for Lp-PLA2 in all subjects were recorded. The serum Lp-PLA2 level was detected by enzyme-linked immunosorbent assay. The correlation of baseline Lp-PLA2 was analyzed. Then Lp-PLA2 level was further divided into four groups in quartile, and logistic regression and receiver operating characteristic curve analysis were performed.Results Lp-PLA2 level was higher in case group than that in control group, and the difference was statistically significant[(1571.9±57.4)ng/ml vs. (1143.6±262.5)ng/ml, P< 0.001]. Multiple analysis showed that, after adjustment of related risk factors, including gender, systolic pressure and bloodglucose at admission, history of smoking, body mass index and history of stroke, the Lp-PLA2 level in case group was still significantly higher than control group, the difference is significant(odds ratio=1.003, 95%confidence interval=1.001-1.004, P=0.001). Then Lp-PLA2 level was divided into four groups in quartile, logistic regression analysis showed that, elevatedLp-PLA2 level had increased the risk of AT. Before adjustment of related risk factors, the highest quartile of Lp-PLA2 level predicting risk of AT was 20.864 times of that of the lowest quartile (P<0.001). After adjustment of related risk factors, the highest quartile of Lp-PLA2 level predicting risk of AT was 9.200 times of that of the lowest quartile (P=0.003). Receiver operating characteristic analysis showed that Lp-PLA2=1531.4 ng/ml can be used as the standard for predicting AT happening, the sensitivity was 48.8% and the specificity was 92.5%, AUC=0.76.Conclusion Lp-PLA2 level is a novel inflammatory indicator that could predict AT happening. A higher Lp-PLA2 level indicates a higher risk of AT. Lp-PLA2≥1531.4 ng/ml has an important role in predicting AT happening.

Key words: Phospholipase A2; lipoprotein; Stroke; Atherothrombosis; Risk factors

摘要： 目的 探讨血清脂蛋白相关磷脂酶A2（1ipoprotein-associated phospholipase A2，Lp-PLA2）水平对动脉粥样硬化血栓形成（atherothrombosis，AT）性卒中发生风险的预测价值。方法 采用病例-对照研究，按照肝素治疗急性卒中研究（Trial of Org 10172 in Acute Stroke Treatment，TOAST）分型标准纳入急性AT患者80例为病例组，同期纳入80例体检中心年龄匹配的无心脑血管病的受试者作为对照组。所有纳入对象均记录动脉粥样硬化相关危险因素及影响Lp-PLA2水平潜在危险因素。采用酶联免疫吸附法（enzyme-linked immunosorbent assay，ELISA）检测血清Lp-PLA2水平，比较两组间基线Lp-PLA2水平，进一步将Lp-PLA2水平按四分位数分为4组，采用Logistic回归模型进行多因素分析。应用受试者特征工作曲线（receiver operating characteristic curve，ROC）分析评价Lp-PLA2对AT发生的预测价值。结果 病例组血清Lp-PLA2水平高于对照组，差异有显著性［（1571.9±57.4）ng/ml vs （1143.6±262.5）ng/ml，P＜0.001］。多因素分析校正性别、入院时收缩压、入院时血糖、吸烟史、体重指数（body mass index，BMI）及家族卒中史等因素后，病例组血清Lp-PLA2水平仍高于对照组，差异有显著性［比值比（odds ratio，OR）1.003，95%可信区间（confidence interval，CI）1.001～1.004，P=0.001］。将Lp-PLA2水平按四分位数分为4组，采用Logistic回归分析，结果表明，发生AT事件随Lp-PLA2水平的升高而增加；未校正任何危险因素时，最高四分位Lp-PLA2水平发生AT风险是最低四分位的20.864倍（P＜0.001）；校正相关危险因素后，最高四分位Lp-PLA2水平发生AT风险是最低四分位的9.200倍（P=0.003）。ROC分析结果表明，以Lp-PLA2水平1531.4 ng/ml作为预测AT发生的界点，其灵敏度为48.8%，特异度92.5%，曲线下面积（area under the curve，AUC）为0.76。结论 Lp-PLA2可能是预测AT发生的新型生物标志物，Lp-PLA2水平越高，AT发生风险越高；Lp-PLA2水平≥1531.4 ng/ml对预测AT发生可能有重要预测价值。

关键词: 磷脂酶A2; 脂蛋白; 卒中; 动脉粥样硬化血栓形成; 危险因素