| Part one.Study on the relationship between ankle brachial index,lipoprotein-associated phospholipase A2 and carotid atherosclerosis in acute cerebral infarctionObjective: To realize the correlation between ankle-brachial index(ABI),lipoprotein-associated phospholipase A2(Lp-PLA2)and carotid atherosclerosis in acute cerebral infarction.Besides,the influencing factors of abnormal ABI of cerebral infarction were analyzed as well.Materials and Methods: We enrolled consecutive patients with first-ever cerebral infarction hospitalized in the Department of Neurology at our Hospital between May 2016 and December 2016.Record all patients age,gender,previous risk factors(hypertension,diabetes,coronary heart disease,smoking,drinking),cholesterin(CHOL),triglycerides(TG),low density lipoprotein(LDL),high density lipoprotein(HDL),fasting plasma glucose(FPG),serum uric acid(UA),high-sensitivity c-reactive protein(HS-CRP),Lp-PLA2,ABI values and carotid ultrasonographic findings,and divided them into non-atherosclerosis group and atherosclerosis group according to the results of carotid ultrasound examination.Clinical characteristics,Lp-PLA2 and ABI values were compared between the 2 groups.After the ABI was detected,the patients were divided into 2 groups: normal ABI group(0.9<ABI≤1.4),abnormal ABI group(ABI≤0.9),Clinical characteristics and Lp-PLA2 were compared between the 2 groups as well.Variables with a P<0.05 in the univariate analysis were considered in the binary logistic regression analysis.Results: Of the 162 patients with first-ever cerebral infarction(mean age 66.78±11.06 years;men101,women 61).1.Atherosclerosis was found in 107(66%),non-atherosclerosis was found in 55(34%).In univariable analysis,prevalence of hypertension(73.83% v 58.18%)and smoking(67.30% v 45.45%),the levels of CHOL(4.40(3.81,5.34)v 3.98(3.33,5.27)),LDL(2.88±0.90 v 2.53±0.95)and Lp-PLA2(269.31±80.72 v 223.35±57.46)were higher in atherosclerosis group compared to non-atherosclerosis group,the differences were statistically significant(P=0.041;0.007;0.037;0.024;0.000,respectively).ABI of atherosclerosis group was 1.09(0.91,1.19),which was lower than 1.18(1.11,1.25)in non-atherosclerosis group,and the difference was statistically significant(P=0.000).In binary logistic regression analysis,only low ABI and high Lp-PLA2 remained independently associated with carotid atherosclerosis,balanced other risk factors.2.Normal ABI was found in 133(82.1%),abnormal ABI was found in 29(17.9%).The patients in normal and abnormal ABI groups showed significant differences in prevalence of smoking(89.66% v 53.38%),the levels of CHOL(5.51(4.19,6.10)v 4.20(3.55,5.01)),TG(1.76(1.16,2.73)v 1.22(0.93,1.82)),LDL(3.23±0.91 v 2.66±0.90),HDL(1.12±0.32 v 1.27±0.30),HS-CRP(6.53(3.22,12.00)v 3.38(1.41,10.02))and Lp-PLA2(307.07±71.79 v 242.07±72.86),the differences were statistically significant(P=0.000;0.000;0.010;0.002;0.019;0.024;0.000,respectively).According to the multivariate analysis,smoking and high Lp-PLA2 were independent predictors of abnormal ABI in acute ischemic stroke.Conclusions: 1.ABI and Lp-PLA2 are strongly related to the carotid atherosclerosis in patients with acute cerebral infarction.Low ABI and high Lp-PLA2 are the independent predictors of carotid atherosclerosis.2.Smoking and Lp-PLA2 were independent predictors of abnormal ABI in acute ischemic stroke.Combination of ABI and Lp-PLA2 can provide some help for the clinic treatment and prevention of acute ischemic stroke.Part two.Study on the relationship between ankle brachial index,lipoprotein-associated phospholipase A2 and the stability of carotid plaque in acute cerebral infarctionObjective: The purpose of the study was to evaluate the relationship between ABI、Lp-PLA2 and the stability of carotid plaque,by comparing ABI and plasma level of Lp-PLA2 in different plaque subtypes of patients with cerebral infarction.Materials and Methods: We recruited patients with first-ever cerebral infarction hospitalized in the Department of Neurology at our Hospital between May 2016 and December 2016,both of whom had carotid plaque.And divided them into 3 groups according to the results of carotid ultrasound examination,included stable plaque group,vulnerable plaque group and mixed plaque group(vulnerable plaque group and mixed plaque group all belong to unstable group).Serum Lp-PLA2 concentration and ABI value were measured as well.Lp-PLA2 and ABI value were compared between groups,to detect the relationship between ABI、Lp-PLA2 and the stability of carotid plaque.Results: Within 107 patients(mean age 68.60±10.84 years;men 67,women 40),55(51%)were stable plaque group,52(49%)were unstable plaque group,(22(21%)were vulnerable plaque group,30(28%)were mixed plaque group).1.The Lp-PLA2 level of the unstable plaque group was higher than the stable plaque group(P=0.002).ANOVA analysis showed that the Lp-PLA2 levels were significantly different among the 3 groups(P=0.008).LSD-t test showed,plasma level of Lp-PLA2 was significantly higher in patients with vulnerable plaque(294.73±80.96ng/ml)compared to those with stable plaque(246.05±77.15 ng/ml)(P=0.015),the Lp-PLA2 level of the mixed plaque group(293.30±80.72ng/ml)was higher than the stable plaque group(P=0.009),and there were no statistical differences between the vulnerable plaque group and mixed plaque group(P>0.05).2.The ABI value between unstable plaque and stable plaque group had no differences(P>0.05),Kruskal-Wallis test showed that the ABI value between 3 groups had no significant differences(P>0.05).The ABI value in stable plaque group was 1.09(0.97,1.20),vulnerable plaque group was 1.00(0.79,1.19),and mixed plaque group was 1.08(0.87,1.18).Conclusions: Lp-PLA2 can be the predictor for the stability of carotid plaque in patients with acute cerebral infarction,the higher the Lp-PLA2 is,more unstable the carotid plaque is.ABI does not appear to be associated with the stability of carotid plaque. |
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