Diagnostic Value of Platelet Endothelial Cell Adhesion Molecule-1 Combined with Serum Lipoprotein-associated Phospholipase A2 in Evaluating the Stability of Carotid Atherosclerotic Plaque

doi:10.12114/j.issn.1007-9572.2020.00.331

Abstract

Abstract: Background　The shedding and rupture of carotid atherosclerotic plaques are independent risk factors for acute stroke，but the stability of carotid atherosclerotic plaques lacks quantitative evaluation indicators.Objective　To explore the diagnostic value of platelet endothelial cell adhesion molecule-1 （PECAM-1/CD31）combined with serum lipoprotein-associated phospholipase A2 （Lp-PLA2）in evaluating the stability of carotid atherosclerotic plaque.Methods　139 patients with carotid atherosclerosis plaque admitted to Department of Neurology，the First Affiliated Hospital of Guangxi Medical University from October 2017 to March 2019 were enrolled，including 76 with unstable plaques and 63 with stable plaques detected by contrast-enhanced ultrasound.Gender，age，BMI，smoking，drinking，hypertension and atrial fibrillation prevalence，fasting plasma glucose（FPG），serum white blood count（WBC），red blood count（RBC），neutrophil count，platelet，creatinine，uric acid，fibrinogen，high-sensitivity C-reactive protein（hs-CRP），total cholesterol，triacylglycerol，high-density lipoprotein，low-density lipoprotein and Lp-PLA2，and PECAM-1/CD31were collected.The independent risk factors affecting the stability of carotid atherosclerotic plaque were screened out by multivariate Logistic regression analysis，and the ROC curve of the indicator，either alone or in combination，was established to evaluate the efficiency in evaluating the stability of carotid atherosclerotic plaque.Results　The prevalence of smoking and atrial fibrillation，average levels of hs-CRP，total cholesterol，triacylglycerol，high-density lipoprotein，low-density lipoprotein，PECAM-1 / CD31，and Lp-PLA2 in unstable plaque group were higher than those of stable plaque group（P<0.05）.Multivariate Logistic regression analysis showed that low-density lipoprotein 〔OR=2.453，95%CI（2.322，2.591）〕，PECAM-1/CD31 〔OR=1.372，95%CI（1.166，1.614）〕and Lp-PLA2〔OR=1.827，95%CI（1.565，2.133）〕were associated with the occurrence of unstable carotid atherosclerotic plaques（P<0.05）.PECAM-1 / CD31（r=0.090，P=0.031）and Lp-PLA2（r=0.090，P=0.005）were significantly positively correlated with low-density lipoprotein.The area under the ROC curve（AUC）of PECAM-1 / CD31 for the diagnosis of stability of carotid atherosclerotic plaque was 0.686〔95%CI（0.224，0.405）〕，when the optimal cut-off point was determined as 11.050 mg / L，with 77.60% sensitivity and 60.30% specificity.The AUC of Lp-PLA2 was 0.724〔95%CI（0.189，0.364）〕，when the optimal cut-off point was determined as 176.585 mg / L，with 98.70% sensitivity and 47.60% specificity.And the AUC of PECAM-1 / CD31 in combination with Lp-PLA2 was 0.875〔95%CI（0.112，0.254）〕，when the optimal cut-off point was determined as 125.28 mg / L，with a sensitivity of 89.50%，and a specificity of 83.20%.Conclusion　Either PECAM-1 / CD31 or Lp-PLA2 showed efficiency in diagnosing unstable carotid atherosclerotic plaque.The combination of the two showed higher value，which may be used as a quantitative diagnostic indicator.

Key words: Atherosclerosis, Carotid atherosclerotic plaque, Latelet endothelial cell adhesion molecule l, Lipoprotein Associated Phospholipase A2, Ischemic stroke

摘要： 背景　颈动脉粥样硬化斑块的脱落及破裂出血是诱发急性脑卒中的独立危险因素，但是关于颈动脉粥样硬化斑块的稳定性尚缺乏定量的评估指标。目的　探究血小板内皮细胞黏附分子1（PECAM-l/CD31）联合血清脂蛋白相关磷脂酶A2（Lp-PLA2）对颈动脉粥样硬化斑块稳定性的诊断价值。方法　选择2017年10月—2019年3月广西医科大学第一附属医院神经内科收治颈动脉粥样硬化斑块患者139例作为研究对象，根据超声造影检查结果，分为不稳定斑块组（76例）和稳定斑块组（63例），记录两组患者的性别、年龄、体质指数（BMI）、吸烟、饮酒、高血压、心房颤动情况，并检测其空腹血糖、白细胞计数、红细胞计数、中性粒细胞计数、血小板计数、血肌酐、尿酸、纤维蛋白原、超敏C反应蛋白、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、PECAM-1/CD31 、Lp-PLA2水平。采用多因素Logistics回归分析筛选出影响颈动脉粥样硬化斑块稳定性的独立危险因素，建立各指标的受试者工作特征（ROC）曲线，评估各指标及联合指标对颈动脉不稳定斑块的诊断效能。结果　不稳定斑块组吸烟比例、心房颤动比例及超敏C反应蛋白、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、PECAM-1/CD31 、Lp-PLA2水平高于稳定斑块组（P<0.05）。多因素Logistic回归分析结果显示，低密度脂蛋白〔OR=2.453，95%CI（2.322，2.591）〕、PECAM-1/CD31 〔OR=1.372，95%CI（1.166，1.614）〕和Lp-PLA2〔OR=1.827，95%CI（1.565，2.133）〕是颈动脉不稳定斑块发生的影响因素（P<0.05）。PECAM-1/CD31（r=0.090，P=0.031）、Lp-PLA2（r=0.090，P=0.005）与低密度脂蛋白呈正相关。PECAM-1/CD31诊断颈动脉粥样硬化斑块稳定性的ROC曲线下面积（AUC）为0.686〔95%CI（0.224，0.405）〕，最佳诊断点为11.050 mg/L，灵敏度为77.60%，特异度为60.30%；Lp-PLA2的AUC为0.724〔95%CI（0.189，0.364）〕，最佳诊断点为176.585 mg/L，其灵敏度为98.70%，特异度为47.60%；而两者联合诊断颈动脉不稳定斑块的AUC为0.875〔95%CI（0.112，0.254）〕，最佳诊断点为125.28 mg/L，其灵敏度为89.50%，特异度为83.20%。结论　PECAM-1/CD31和Lp-PLA2对颈动脉不稳定斑块具有一定的诊断价值，两者联合诊断价值较高，可作为颈动脉不稳定斑块的定量诊断指标。

关键词: 动脉粥样硬化, 颈动脉粥样硬化斑块, 血小板内皮细胞黏附分子1, 脂蛋白相关磷脂酶 A2, 缺血性脑卒中

HUANG Liqiang,CHENG Daobin,YE Ziming, et al. Diagnostic Value of Platelet Endothelial Cell Adhesion Molecule-1 Combined with Serum Lipoprotein-associated Phospholipase A2 in Evaluating the Stability of Carotid Atherosclerotic Plaque　[J]. Chinese General Practice, 2021, 24(2): 170-175. DOI: 10.12114/j.issn.1007-9572.2020.00.331.
黄利强,程道宾,叶子明等. 血小板内皮细胞黏附分子1联合血清脂蛋白相关磷脂酶A2对颈动脉粥样硬化斑块稳定性的诊断价值[J]. 中国全科医学, 2021, 24(2): 170-175. DOI: 10.12114/j.issn.1007-9572.2020.00.331.

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