Abstract
We aimed to study the clinical utility of serum lipoprotein-associated phospholipase A2 (Lp-PLA2) in acute ischemic stroke (AIS) with cerebral artery stenosis (CAS). We included 200 AIS patients and 90 healthy controls in this study. AIS patients were classified into three subgroups depending on the severity of CAS. They were also classified based on the stability of the carotid plaques. Spearman correlation analysis was performed to determine the correlation relationship between the level of Lp-PLA2 and neurologic injury. Binary 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. We found that the serum level of Lp-PLA2 in AIS patients was significantly higher than that in the control group. Lp-PLA2 was further identified as an independent risk factor for AIS (p = 0.001, OR = 1.057). In addition, serum Lp-PLA2 level was the highest in AIS patients with severe CAS or occlusion. Lp-PLA2 level was higher in AIS patients with unstable plaques and in AIS patients with moderate to severe neurological injury. Lp-PLA2 level was positively correlated with National Institutes of Health Stroke Scale (NIHSS) score (r = 0.335, p = 0.001). We found that the optimal cut-off value for Lp-PLA2 level was 123.365 ng/ml, at which the sensitivity and specificity for the diagnosis of ACI 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 were 79.6 and 95.2%, respectively, and the AUC was 0.938. The ROC curve indicated that serum Lp-PLA2 level has an excellent diagnostic value for AIS and severe stenosis. Based on these results we conclude that Lp-PLA2 could be a potential biomarker to complement the current imaging methods in the prediction and 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.
Highlights
Acute ischemic stroke (AIS) has a high incidence, disability, mortality, and recurrence rate, which often places a tremendous pain and burden on the patient, the family and the society [1]
The following variables, including the percentage of people with hypertension or diabetes mellitus, and the levels of SBP, DBP, total cholesterol (TC), TG, low-density lipoproteins (LDLs)-C, Glu were higher in the AIS group, whereas the level of high density lipoprotein cholesterol (HDL-C) was higher in the controls
We found that when the optimal serum level of Lp-PLA2 was set at 123.365 ng/ml, the sensitivity and specificity for the diagnosis of AIS using Lp-PLA2 were 74.5 and 86.7%, respectively, and the area under Receiver operating characteristic (ROC) curve (AUC) was 0.892 (p < 0.05, 95% confidence interval (CI): 0.856–0.929) (Figure 3A)
Summary
Acute ischemic stroke (AIS) has a high incidence, disability, mortality, and recurrence rate, which often places a tremendous pain and burden on the patient, the family and the society [1]. Atherosclerotic plaque formation is an early pathological feature of carotid lesions, which can gradually develop into vascular stenosis and may completely block the cerebral blood flow, leading to AIS [3, 4]. The role of atherosclerosis as an independent risk factor in AIS has been extensively studied. As a new vascular-specific inflammatory factor, Lp-PLA2 can be broadly involved in the progression of atherosclerosis, including the formation, development and rupture of the plaque [8]. Elevated Lp-PLA2 levels are strongly associated with atherosclerosis-related diseases, including heart disease and ischemic stroke [9, 10]. The aim of this study was to analyze the role of Lp-PLA2 in the acute ischemic stroke with cerebral artery stenosis and provide guidance for clinical application of this biomarker
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