Clinical Utility Of The Serum Level Of Lipoprotein-Related Phospholipase A2 In Acute Ischemic Stroke With Cerebral Artery Stenosis

Objective To explore the clinical utility of serum lipoprotein-associated phospholipase A2(LP-PLA2)in acute ischemic stroke(AIS)with cerebral artery stenosis(CAS).Methods From April 2018 to April 2019,200 patients with acute ischemic stroke(AIS group)admitted to the Department of Neurology of the First Affiliated Hospital of Anhui Medical University.90 healthy patients matched with age and gender were selected as control group(NC group).According to computed tomography angiography(CTA)of the head and neck,the AIS patients were divided into a non-mild cerebrovascular stenosis group of 63 cases,a moderate cerebrovascular stenosis group of 41 cases,and a severe cerebrovascular stenosis or occlusion group of 96 cases.According to the National Institutes of Health Stroke Scale(NIHSS)scores,AIS patients were divided into a mild neurological deficit group of 110 cases and a moderate-severe neurological deficit group of 90 cases.Carotid artery ultrasound was used to divide AIS patients into unstable plaque group 131 cases and non-unstable plaque 69 cases.Spearman correlation analysis was performed to determine the correlation relationship between the level of LP-PLA2 and neurologic injury.Multivariate logistic regression analysis was performed to determine the independent risk factors for AIS.Receiver operating characteristic(ROC)analysis was performed to assess the diagnostic value of LP-PLA2 for AIS and for the degree of CAS.Results The serum level of LP-PLA2 in AIS patients was significantly higher than that in the control group.Serum LP-PLA2 levels increased in the no/mild stenosis group,moderate stenosis group,and severe stenosis or occlusion group,and the difference was statistically significant.The serum LP-PLA2 level in the unstable plaque group was significantly higher than that in the non-unstable plaque group.The level of LP-PLA2 in the moderate-severe neurological deficit group was higher than that of the mild neurological deficit group.LP-PLA2 level was positively correlated with NIHSS score(r=0.335,p=0.001).Binary logistic regression analysis was performed to determine the independent risk factors for AIS(p=0.001,OR=1.057).We found that the optimal cut-off value for LP-PLA2 level was 123.365ng/ml,at which the sensitivity and specificity for the diagnosis of AIS were 74.5% and 86.7%,respectively,and the area under ROC curve(AUC)was 0.892.Similarly,the optimal value for LP-PLA2 level was 136.46 ng/ml,at which the sensitivity and specificity for the diagnosis of the presence of moderate to severe artery stenosis or occlusion were79.6% and 95.2%,respectively,and the AUC was 0.938.Conclusion Based on these results we conclude that LP-PLA2 could be a potential biomarker to complement the current imaging methods in diagnosis of AIS.An elevated LP-PLA2 level is also correlated with carotid plaque instability,severe neurological injury and cerebrovascular stenosis.Future longitudinal studies are needed to determine whether there is a causative relationship between LP-PLA2 and AIS.