血清可溶性CD40配体及基质金属蛋白酶9水平在老年缺血性脑卒中患者颈动脉斑块不稳定中的诊断价值
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(1.烟台市蓬莱中医医院 检验科,山东 烟台 265600;2.烟台市蓬莱中医医院 输血科,山东 烟台 265600)

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R743.31

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山东省中医药科技计划项目(2020Q090)


Diagnostic value of serum levels of soluble CD40 ligand and matrix metalloproteinase-9 in carotid plaque instability in elderly patients with ischemic stroke
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(1.Department of Laboratory,Yantai 265600, Shandong Province, China;2.Department of Blood Transfusion, Yantai Penglai Hospital of Traditional Chinese Medicine, Yantai 265600, Shandong Province, China)

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    摘要:

    目的 探讨血清可溶性CD40配体(sCD40L)、基质金属蛋白酶9(MMP-9)在老年缺血性脑卒中(CIS)患者颈动脉斑块不稳定性中的诊断价值。方法 回顾性分析2021年8月至2022年12月烟台市蓬莱中医医院收治的266例老年(年龄≥60岁)CIS患者的临床资料(CIS组),另选取同期在本院体检的234例健康志愿者为对照组,比较两组血清sCD40L及MMP-9水平,分析二者在CIS早期诊断中的价值。依据老年CIS患者颈动脉斑块情况将CIS组患者分为斑块稳定组(n=106)与斑块不稳定组(n=160),分析老年CIS患者斑块不稳定的影响因素,并探讨血清sCD40L、MMP-9水平在老年CIS患者颈动脉斑块不稳定性中的诊断价值。采用SPSS 20.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ2检验进行组间比较。采用多因素logistic回归分析老年CIS患者颈动脉斑块不稳定的影响因素。采用ROC曲线分析血清学指标在老年CIS患者颈动脉斑块不稳定性中的诊断效能。结果 CIS组患者血清sCD40L和MMP-9水平显著高于对照组,差异有统计学意义(P<0.05);对照组患者经检测均为无斑块,CIS组检测出斑块稳定者106例,斑块不稳定者160例。斑块不稳定组与斑块稳定组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、sCD40L、MMP-9、纤维蛋白原(FIB)、白细胞计数(WBC)水平比较,差异有统计学意义(t=13.008、9.511、14.514、20.972、13.252、16.344、10.232,P<0.05)。多因素logistic回归分析显示,TC(OR=1.758,95%CI 1.083~2.852)、LDL-C(OR=2.275,95%CI 1.045~4.954)、sCD40L(OR=1.956,95%CI 1.112~3.440)及MMP-9(OR=1.846,95%CI 1.151~2.961)是CIS患者颈动脉斑块不稳定的独立危险因素(P<0.05)。血清sCD40L、MMP-9水平对老年CIA患者颈动脉不稳定斑块诊断曲线下面积(AUC)分别为0.967和0.939。结论 TC、LDL-C、sCD40L及MMP-9是CIS患者颈动脉斑块不稳定的独立危险因素,临床需加强对以上指标的监测。另血清sCD40L和MMP-9水平的监测,可为CIA早期诊断及CIA患者颈动脉斑块不稳定性评估提供客观依据。

    Abstract:

    Objective To investigate the diagnostic value of serum soluble CD40 ligand (sCD40L) and matrix metalloproteinase-9 (MMP-9) in carotid plaque instability in the elderly patients with cerebral ischemic stroke (CIS). Methods A retrospective analysis was made of the clinical data of 266 elderly (≥60 years old) CIS patients (CIS group) admitted to Yantai Penglai Hospital of Traditional Chinese Medicine from August 2021 to December 2022 and 234 healthy volunteers who underwent physical examination in the same hospital during the same period (control group). The two groups were compared in serum sCD40L and MMP-9 levels to analyze their value in the early diagnosis of CIS. According to the carotid plaque status, the CIS group was divided into a plaque stable group (n=106) and a plaque unstable group (n=160). The factors affecting plaque instability in the elderly CIS patients were analyzed, and the diagnostic value of serum sCD40L and MMP-9 levels in the carotid plaque instability among them was investigated. SPSS statistics 20.0 was used to analyze the data. Depending on the data type, t test orχ2 test was used for comparison between groups. Multivariate logistic regression was used to analyze the factors affecting carotid plaque instability in the elderly CIS patients, and the ROC curve was used to analyze the diagnostic efficacy of serological indicators in carotid plaque instability in them. Results The serum levels of sCD40L and MMP-9 in the CIS group were significantly higher than those in control group with statistically significant difference (P<0.05). All patients in the control group were plaque free, and in the CIS group, 106 patients had stable plaques and 160 patients unstable plaques. In comparison, the plaque unstable group and the plaque stable group showed statistically significant differences in the levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), sCD40L, MMP-9, fibrinogen (FIB) and white blood cell count (WBC) (t=13.008,9.511,14.514,20.972,13.252,16.344,10.232; P<0.05). Multivariate logistic regression analysis showed that TC (OR=1.758,95%CI 1.083-2.852), LDL-C (OR=2.275,95%CI 1.045-4.954), sCD40L (OR=1.956, 95%CI 1.112-3.440), and MMP-9 (OR=1.846,95%CI 1.151-2.961) were independent risk factors of carotid plaque instability in CIS patients (P<0.05). The area under the curve (AUC) of serum sCD40L and MMP-9 for carotid artery unstable plaque diagnosis in elderly CIA patients was 0.967 and 0.939, respectively. Conclusion TC, LDL-C, sCD40L and MMP-9 are independent risk factors for carotid plaque instability in CIS patients, and clinical monitoring of these indicators should be strengthened. In addition, the monitoring of serum sCD40L and MMP-9 levels can provide an objective basis for the early diagnosis of CIA and the assessment of carotid plaque instability in CIA patients.

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张巧云,金迺光,王晓娜,任秀慧.血清可溶性CD40配体及基质金属蛋白酶9水平在老年缺血性脑卒中患者颈动脉斑块不稳定中的诊断价值[J].中华老年多器官疾病杂志,2024,23(5):360~364

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  • 收稿日期:2023-06-13
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  • 在线发布日期: 2024-05-15
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