The influence of chronic Helicobacter pylori infection in serum lipoprotein associated phospholipase A2 level and stability of atherosclerotic plaques in patients with carotid atherosclerosis

Objective To evaluate the diagnostic value of lipoprotein-associated phospholipase A2 (Lp-PLA2) and carotid artery ultra sound for transient ischemic attack (TIA) . Methods Ninety patients with TIA of internal carotid artery system in the acute phase and 55 normal control subjects were recruited. Their carotid intima-media thicknesses were assessed by carotid ultrasonography. Serum Lp-PLA2 levels were determined by enzyme-linked immunosorbentassay(ELISA) ,and all the data were compared between the two group. Results The detection rate of carotid atherosclerotic plaque in the TIA group was significantly higher than that in the control group f 78. 9% (71/90) vs. 29. 1% (16/55), x2 = 35. 27, P < 0.01] . There were 35 carotid atherosclerotic plaque in the control group,of which 6 were unstable plaques and 29 were stable plaques. There were 134 carotid atherosclerotic plaque in the TIA group,of which 103 were unstable plaques and 31 were stable plaques, the constituent ratio of unstable plaque in the TIA group was significantly higher than that in the control group (x2 =43. 22 ,P < 0. 01). The levels of serum Lp-PLA2 in male and female patients in TIA group were ([19. 08 ±7. 92] mol/(min · ml) and [15. 15 ±4. 91] mol/(min · ml),which were significantly higher than those in male and female in the control group ([13. 86 ± 3. 15] mol/(min · ml) and [11. 18 ± 2. 96] mol/ (min · ml) (t = 3. 8598 and 2. 9260, respectively, Ps < 0. 01). Furthermore, the levels of serum Lp-PLA2 of males in the TIA group and control group were significantly higher than that of females in the TIA group and control group(t=2. 3850 and 2. 9143, respectively, Ps < 0.05). The level of serum Lp-PLA2 in unstable plaque patients in the TIA group was (20.16 ± 6. 76) mol/ (min · ml) , which was significantly higher than that in stable plaque patients in the TIA group was (16. 09 ±4. 15)mol/(min · ml) ,the difference was statistically significant (t = 2. 5578, P < 0. 05). Conclusion Serum Lp-PLA2 is a risk factor of carotid atherosclerotic plaque, the combination of Lp-PLA2 and carotid ultrosonography can be used and alert indicator of TIA. Key words: Transient ischemic attack; Lipoprotein-associated phospholipase A2; Carotid ultrosonography

Purpose To measure serum levels of ischaemia-modified albumin (IMA) and lipoprotein-associated phospholipase A2 (LP-PLA2) in patients with coronary heart disease (CHD) and to analyse their correlation with the degree of myocardial ischaemia and their diagnostic value. Methods A sample of 150 patients diagnosed with CHD by coronary angiography in our hospital from March 2019 to September 2021 was taken as the CHD group. The patients were divided into acute myocardial infarction (AMI) group (n = 52), unstable angina pectoris (UAP) group (n = 54), and stable angina pectoris (SAP) group (n = 44) according to the degree of myocardial ischaemia, and then 50 healthy physical examination patients were selected as the health group during the same period. Serum C-reactive protein (CRP), interleukin-6 (IL-6), IMA, and LP-PLA2 levels were measured in each group separately. Multiple ordered logistic regression was used to analyse the factors influencing the degree of myocardial ischaemia in patients with CHD. Pearson correlation was used to analyse the correlation between serum IMA, LP-PLA2 levels and serum CRP, IL-6 levels in CHD patients. The diagnostic value of IMA alone, LP-PLA2 alone, and in combination for CHD was analysed using receiver operating characteristic (ROC) curves. Results In terms of serum CRP, IL-6, IMA, and LP-PLA2 levels, the CHD group was higher than the health group, the AMI and UAP groups were higher than the SAP and health groups, and the AMI group was higher than the UAP group (P < 0.05). Multiple ordered logistic regression analysis showed that serum CRP, IL-6, IMA, and LP-PLA2 levels were all independent influences on the degree of myocardial ischaemia in patients with CHD (P < 0.05). Pearson correlation analysis showed a positive correlation between serum IMA, LP-PLA2 levels and serum CRP, IL-6 levels in CHD patients (P < 0.001). The area under curve (AUC) for serum IMA levels to predict myocardial ischaemia in patients with CHD was 0.754 (95% CI: 0.684–0.825), with a sensitivity of 61.3% and specificity of 84.0% when the best cut-off value was 0.453; the AUC for serum LP-PLA2 levels to predict myocardial ischaemia in patients with CHD was 0.747 (95% CI: 0.681–0.813), with a sensitivity of 62.0% and specificity of 82.0% when the optimal cut-off value was 0.440; and the AUC of IMA + LP-PLA2 for predicting myocardial ischaemia in patients with CHD was 0.892 (95% CI: 0.847–0.938), with a sensitivity of 86.7% and specificity of 80.0% when the optimal cut-off value was 0.667. The specificity was 80.0%. Conclusions Serum IMA and LP-PLA2 levels are elevated in patients with CHD. Serum IMA and LP-PLA2 levels are closely related to the degree of myocardial ischaemia and its inflammatory level, and the combination of IMA + LP-PLA2 can improve the diagnosis efficacy of myocardial ischaemia in CHD patients.

Plasma levels of lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) and oxidized low density lipoprotein (oxLDL) have been identified as risk factors for cardiovascular disease. Lp-PLA(2) is the sole enzyme responsible for the hydrolysis of oxidized phospholipids on LDL particles in atherosclerotic plaques. We have studied the relationship between Lp-PLA(2) and oxLDL in carotid endarterectomy (CEA) tissues and in matched plasmas. In extracts from CEA anatomical segments, the levels of oxLDL were significantly associated with the levels of Lp-PLA(2) protein (r = 0.497) and activity (r = 0.615). OxLDL and Lp-PLA(2) mass/activity were most abundant in the carotid bifurcation and internal segments where plaque was most abundant. In extracts from CEA atheroma, the levels of oxLDL and Lp-PLA(2) were significantly correlated (r = 0.634). In matched plasma and atheroma extracts, the levels of Lp-PLA(2) were negatively correlated (r = - 0.578). The ratio of Lp-PLA(2) to oxLDL was higher in atheromatous tissue (277:1) than in normal tissue (135:1) and plasma (13:1). Immunohistochemical experiments indicated that in plaques, oxLDL and Lp-PLA(2) existed in overlapping but distinctly different distribution. Fluorescence microscopy showed both oxLDL and Lp-PLA(2) epitopes on the same LDL particle in plasma but not in plaque. These results suggest that the relationship between Lp-PLA(2) and oxLDL in the atherosclerotic plaque is different from that in the plasma compartment.

Objective To investigate the clinical use of carotid ultrasonography and human plasma lipoprotein associated phospholipase A2 (Lp-PLA2) in the diagnosis and treatment of atherosclerotic cerebral infarction. Methods Eighty patients with atherosclerotic cerebral infarction, who were hospitalized in the Department of Neurology in our hospital between April 2015 and June 2016, were included in the study group, and 60 healthy subjects were included in the control group. The carotid ultrasonography was used to determine the formation of carotid intima plaque and carotid intima-media thickness (IMT) . The Lp-PLA2 was determined by luminescence immunoassay. The detection rate of carotid plaque, and the levels of IMT and Lp-PLA2 were compared between the two groups. According to the National Institutes of Health Stroke Scale (NIHSS) score, the study group was divided into the mild, moderate and severe sub-groups. The differences in the levels of IMT and Lp-PLA2 were compared between the sub-groups. The correlation between NIHSS score and the levels of IMT and Lp-PLA2 in the study group was analyzed. Results The detection rate of carotid plaque in the study group was higher than that in the control group (85% vs 63.33%, P<0.05) . The levels of IMT and Lp-PLA2 in the study group were higher than those in the control group [ (1.25±0.61) mm vs (0.67±0.31) mm, (187.33±60.31) ng/ml vs (166.18±56.16) ng/ml, P<0.05]. Among the sub-groups, the levels of IMT and Lp-PLA2 were the highest in the severe group, and the lowest in the mild group (P<0.05) . In addition, there was positive linear correlation between the NIHSS score and the levels of IMT and Lp-PLA2 in the study group (r=0.857, 0.672, P<0.05) . Conclusion The carotid ultrasonography and Lp-PLA2 show certain predictive value for atherosclerotic cerebral infarction, which can be used in the diagnosis and treatment of arteriosclerotic cerebral infarction. Key words: Ultrasonography, Doppler; Cerebral infarction; Arteriosclerosis; Human plasma lipoprotein associated phospholipase A2

The diagnostic and prognostic performance of Lp-PLA2 in acute ischemic stroke

The diagnostic and prognostic performance of Lp-PLA2 in acute ischemic stroke

ObjectiveTo investigate the serum level of cystatin C (CysC), ischemia-modified albumin (IMA), and lipoprotein-associated phospholipase A2 (LP-PLA2) in patients with type 2 diabetes mellitus (T2DM) and with lower extremity atherosclerotic occlusive disease (LEASOD) and their correlation.MethodsFrom March 2017 to December 2019, 110 patients with T2DM with LEASOD, who were treated in our hospital, were selected as the observation group. One hundred ten healthy persons who received medical examination in our hospital during the same period were selected as the control group. Serum CysC, IMA, LP-PLA2, and ankle-brachial index (ABI) were detected in each group. According to the ABI index, the observation group was divided into three subgroups, namely, the mild group (n = 45), the moderate group (n = 42), and the severe group (n = 23). Pearson correlation analysis was used to analyze the relationship between serum CysC, IMA, and LP-PLA2 levels in patients with T2DM with LEASOD and their condition. The receiver operator characteristic (ROC) curve was used to analyze the diagnostic value of serum CysC, IMA, and LP-PLA2 levels in patients with T2DM with LEASOD.ResultsThe serum levels of CysC, IMA, and LP-PLA2 in the observation group were higher than those in the control group (p < 0.05). The serum levels of CysC, IMA, and LP-PLA2 in the severe and the moderate group were higher than those in the mild group, and the serum levels of CysC, IMA, and LP-PLA2 in the severe group were higher than those in the moderate group (p < 0.05). Pearson correlation analysis showed that CysC, IMA, and LP-PLA2 levels were all negatively correlated with ABI (r = −0.802, r = −0.757, r = −0.764, p < 0.001). The ROC curve results showed that the area under the curve (AUC) of serum CysC in the diagnosis of T2DM with LEASOD was 0.806, and the best cut-off value was 1.74 mg/L. The AUC of serum IMA for diagnosis of T2DM with LEASOD was 0.772, and the best cut-off value was 92.58 g/L. The AUC of serum LP-PLA2 in the diagnosis of T2DM with LEASOD was 0.781, and the best cut-off value was 544.86 ng/L. The AUC of the three combined diagnoses of T2DM with LEASOD was 0.863.ConclusionSerum levels of CysC, IMA, and LP-PLA2 were increased in patients with T2DM with LEASOD. Serum CysC, IMA, and LP-PLA2 are closely related to the severity of the disease. The higher the serum levels of CysC, IMA, and LP-PLA2, the more serious the degree of lower extremity arteriosclerosis occlusion, which can be used as an important serum marker to monitor the severity of T2DM with LEASOD. The combined detection of serum CysC, IMA, and LP-PLA2 has good diagnostic value for patients with T2DM with LEASOD.

To explore the relationship between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level and the risk of acute ischemic stroke (AIS) recurrence in hypertensive patients. This retrospective case-control study was conducted among 211 hypertensive patients with AIS treated in Foshan First People's Hospital, including 35 patients with recurrence of AIS during the 1-year follow-up as confirmed by head CT/MR. In the overall patients, 60 had grade 1 hypertension (including 5 recurrent cases), 76 had grade 2 hypertension (with 11 recurrent cases), and 75 had grade 3 hypertension (with 19 recurrent cases). Univariate analysis, multivariate logistic regression analysis, trend analysis, and smooth curve fitting analysis were performed to explore the correlation between serum Lp-PLA2 level within 24 h after admission and the risk of AIS recurrence. The predictive efficacy of serum Lp-PLA2 level for AIS recurrence in different hypertension grades was evaluated using ROC curve analysis. Serum Lp-PLA2 level, age, NIHSS score at admission, mRS scores at 7 days, homocysteine level and smoking status differed significantly between patients with and without AIS recurrence (P < 0.05). After adjustment for confounding factors, multivariate regression analysis showed that the highest tertile of Lp-PLA2 level was associated with a 4.13-fold increase of AIS recurrence risk compared with the lowest tertile (OR=5.13, 95% CI: 1.35-19.40), and each 1 ng/mL increase of Lp-PLA2 level was associated with a 1% increase of AIS recurrence risk (OR= 1.01, 95% CI: 1.01-1.02). Serum Lp-PLA2 level was shown to positively correlate with AIS recurrence risk, and in patients with grade 3 hypertension, its areas under the ROC curve for predicting AIS recurrence was 0.869 with a specificity of 0.893 and a sensitivity of 0.737. Serum Lp-PLA2 concentration is an independent risk factor and potentially an effective predictor for AIS recurrence in patients with grade 3 hypertension.

The purpose of this study was to explore the change of carotid intima-media thickness (IMT) and its correlation with inflammatory markers in patients with different degrees of obstructive sleep apnea (OSA). One hundred hospitalized patients were selected and were divided into the normal control group (21 cases), the mild-moderate group (39 cases) and the severe group (40 cases) according to their apnea hypopnea index (AHI). Carotid IMT of all registered patients was studied with ultrasound, and serum levels of high-sensitivity C-reactive protein (hs-CRP), Lipoprotein-associated phospholipaseA2 (Lp-PLA2) and tumor necrosis factor-α (TNF-α) were measured. Pearson correlation analysis and multiple stepwise regression analysis were used to analyze the correlation between carotid IMT and inflammatory factors. Patients with mild, moderate and severe OSA Carotid IMT had significantly higher levels of serum hs-CRP, Lp-PLA2 and TNF-α compared with the normal control group (P < 0.001). The levels of carotid IMT, serum protein hs-CRP, Lp-PLA2 and TNF-α in the severe OSA group were significantly higher than those of the mild-moderate OSA group, with P values being less than 0.001. Carotid artery IMT was positively correlated with serum hs-CRP (r = 0.83, P < 0.001), Lp-PLA2 (r =0.58, P < 0.001), and TNF-α (r =0.69, P < 0.001). hs-CRP, TNF-α and AHI were independent factors affecting carotid artery IMT. In addition, AHI was an independent indicator of carotid atherosclerosis (P = 0.0012). Increased inflammatory factors in OSA patients might cause the progression of atherosclerosis, which might increase the risk of cardiovascular and cerebrovascular diseases in OSA patients.

Kawasaki disease (KD) is an inflammatory disease associated with coronary vasculitis in children. In this study, we explored the correlation between Lipoprotein associated phospholipase A2 (Lp-PLA2) and coronary artery lesions (CAL) in children with KD. Ninety-three children with KD were divided into a normal coronary artery (NCA, 54 cases) group and coronary artery lesions (CAL, 39 cases) group, according to the results of echocardiography. Another 42 healthy children were selected as the control group. The serumal levels of Lp-PLA2, Interferon-γ(IFN-γ) and Interleukin-6 (IL-6) were determined by using an enzyme-linked immunosorbent assay. In addition, erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) level were analyzed. The left main coronary artery (LMCA), diameters of left anterior descending coronary artery (LADC), right proximal coronary artery (PRCA), and carotid intima-media thickness (IMT) were obtained by color Doppler ultrasound. The correlation between the above indexes and KD was analyzed. The levels of white blood cell counts (WBC), ESR, CRP, IFN-γ, IL-6 and Lp-PLA2 as well as IMT were significantly increased in KD children (P < 0.05), and the levels of CRP, IFN-γ, IL-6 and Lp-PLA2 as well as IMT in the CAL group increased more significantly (P < 0.05). An increasing trend also has been described in the diameters of LMCA, LADC and PRCA for KD children with CAL compared with with NCA. The results of logistic regression analysis showed that the elevated levels of CRP, IFN-γ, IL-6 and Lp-PLA2 were independent risk factors for KD with CAL. Correlation analysis showed that Lp-PLA2 level was positively correlated with the levels of IFN-γ, IL-6 and CRP in CAL group and NCA group (respectively, all P < 0.01). In addition, a similar correlation was also described between Lp-PLA2 level and the diameters of LMCA, LADC and PRCA in CAL group (respectively, all P < 0.01). Lp-PLA2 may participate in the pathological mechanism of KD. Detection of the serum Lp-PLA2 level can be used in the diagnosis of KD disease and the assessment of coronary artery lesions in KD children.

This study aimed to examine the relationship between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) levels and cognitive impairment (CI) in patients with chronic kidney disease (CKD). A total of 125 patients with CKD treated in the Department of Nephrology, The Second Affiliated Hospital of Nantong University from July 2022 to May 2023 were selected and divided into observation group (44 patients with CI) and control group (81 patients with normal cognitive function). Multivariate logistic regression analysis was performed to analyze the risk factors of CI, and Spearman rank correlation analysis was used to analyze the correlation between serum Lp-PLA2 and Montreal Cognitive Assessment Scale (MoCA) score. The truncation value of Lp-PLA2 in CKD patients with CI was analyzed by receiver operating characteristic curve (ROC). Serum Lp-PLA2 levels were significantly elevated in the observation group compared to the control group (P < 0.05). The area under the ROC curve for Lp-PLA2 was 0.849, with a cutoff value of 232ng/mL for identifying CI in patients with CKD. Lp-PLA2 levels were independently associated with CI in patients with CKD (odds ratio [OR] = 0.988, 95% confidence interval [CI]: 0.982-0.993, P < 0.001). Elevated serum Lp-PLA2 levels serve as an independent risk factor for CI in patients with CKD.

Background:Acute coronary syndrome (ACS) is closely related to unstable plaques and secondary thrombosis. The inflammatory cells in plaques and their inflammatory products may be the cause for plaque instability and ruptures. The study aimed to disclose the changes of inflammatory factors including serum intracellular adhesion molecule-1 (ICAM-1), chitinase-3-like protein 1 (YKL-40), and lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with ACS and its clinical significance.Methods:A total of 120 patients with coronary heart disease (CHD) were categorized into 2 groups: 69 with ACS and 51 with stable angina pectoris (SAP); 20 patients with chest pain and normal angiography served as a control group. The 120 patients with CHD were categorized into single-vessel disease group, double-vessel disease group, and three-vessel disease group based on the number of coronary artery stenosis. The severity of coronary artery stenosis was quantified based on coronary angiography using Gensini score. They were further divided into mild CHD group with its Gensini score <26 (n = 36), moderate CHD group with its Gensini score being 26–54 (n = 48) and severe CHD group with its Gensini score >54 (n = 36). Serum levels of ICAM-1, YKL-40, and Lp-PLA2 of different groups were determined by enzyme-linked immunosorbent assay. Correlation between ICAM-1, YKL-40, Lp-PLA2, and Gensini score was analyzed.Results:The levels of serum inflammatory factors ICAM-1, YKL-40, and Lp-PLA2 were significantly higher in the ACS group than those in control group and SAP group (all P < 0.05); and compared with control group, no significant difference was observed in terms of the serum ICAM-1, YKL-40, and Lp-PLA2 levels in the SAP group (P > 0.05).The levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not significantly different among control group, single-vessel disease group, double-vessel disease group, and three-vessel disease group (all P > 0.05). The levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not significantly different among control group, mild CHD group (Gensini score <26), moderate CHD group (Gensini score 26–54), and severe CHD group (Gensini score >54) (all P > 0.05).Conclusions:The serum levels of ICAM-1, YKL-40, and Lp-PLA2 were correlated with different clinical types of CHD, but not well correlated the severity and extent of artery stenosis, suggesting that ICAM-1, YKL-40, and Lp-PLA2 might be involved in occurrence of instability of atherosclerotic plaque, and might reflect the severity of CHD mostly through reflecting the plaque stability.

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an inflammatory marker associated with atherosclerotic and cardiovascular diseases. This study aimed to explore the association of Lp-PLA2 with carotid intima-media thickness (cIMT) in patients with acute ischemic stroke (AIS) and explore a threshold level to predict the risk of vulnerable plaques. This retrospective observational study included patients with AIS in the Neurology Department of our Hospital between January 2018 and December 2019. The study included 293 patients aged 65.29 ± 12.11years, including 212 males, of whom 124 had carotid intima-media thickening (42.32%). Multivariable logistic regression showed that Lp-PLA2 level was an independent risk factor for cIMT (odds ratio [OR] = 1.004, 95% confidence interval [95% CI] 1.001-1.008, P = .008). Threshold effect analysis showed that the risk of vulnerable carotid plaque occurrence increased by 2% for every 1ng/mL increase in Lp-PLA2 level with serum Lp-PLA2 levels between 157 and 279ng/mL; this increase was statistically significant (OR = 1.02, 95% CI 1.01-1.03, P < .001). Serum Lp-PLA2 is an independent risk factor for increased cIMT in patients with AIS, and a threshold Lp-PLA2 level between 157 and 279ng/mL showed a higher risk of carotid plaque rupture.

Serum lipoprotein-associated phospholipase A2 predicts the formation of carotid artery plaque and its vulnerability in anterior circulation cerebral infarction

To observe the changes of neutrophil gelatinase associated apolipoprotein (neutrophil gelatinase associated lipocalin), lipoprotein associated phospholipase A2 and inflammatory cytokine hypersensitive C-reactive protein in patients with coronary heart disease and to explore the correlation between serum lipoproteinassociated phospholipase A2, neutrophil gelatinase associated lipocalin, hypersensitive C-reactive protein and the degree of coronary artery disease in patients with coronary heart disease. 200 inpatients in cardiovascular department of our hospital were divided into coronary heart disease group (n=153) and control group (n=47) according to coronary angiography. The serum levels of lipoprotein-associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein were measured. According to the Gensini score, the patients in the CHD group were divided into mild, moderate, severe and extremely severe groups. The changes of serum lipoprotein associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein was analyzed. At the same time, the relationship between the levels of serum lipoprotein associated phospholipase A2, neutrophil gelatinase associated lipocalin, hypersensitive C-reactive protein and the degree of coronary artery disease was discussed from the three aspects of coronary artery stenosis and Gensini score and the value of combined detection in the diagnosis of coronary heart disease. The serum levels of lipoprotein associated phospholipase A2 lipoprotein associated phospholipase A2 , neutrophil gelatinase-associated lipocalin, hypersensitive C-reactive protein and Gensini score in the coronary heart disease group were significantly higher than those in the control group (p<0.01). The serum levels of lipoprotein-associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein in extremely severe coronary artery disease group were significantly higher than those in moderate to severe disease group, mild disease group and control group (p<0.05) and those in severe disease group were significantly higher than those in mild and moderate disease group and control group (p<0.05). The area under the curve of combined detection of lipoprotein-associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein in the diagnosis of coronary heart disease reached 0.859. The serum levels of lipoprotein associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein are significantly increased in patients with coronary heart disease and are closely related to the severity of coronary artery disease, which can be used to evaluate the severity of coronary artery disease. The diagnostic rate of combined detection of serum lipoprotein associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein for coronary heart disease can reach 0.859, which can provide important clinical guidance value.