脂蛋白磷脂酶A2对颈动脉斑块人群卒中发病预警价值的队列研究

Stoke is the second killer disease in China. Although the mortality in acute stroke was decreasing, the incidence was constantly increasing. Therefore, the key of primary prevention in stroke was to explore the new biomarker and preventable target in early onset. The rupture or thrombosis or block caused by vulnerable plaque of carotid was the important etiology of acute cerebrovascular events. The incident of cerebrovascular events caused by vulnerable plaque was increasing constantly. Inflammation was one of the most important etiology of vulnerable plaque. As the new inflammation biomarker, Lp-PLA2 was the most important reason causing the expansion of lipid core. Therefore, a study on exploring the mechanism of Lp-PLA2 in process of vulnerable plaque. In previous study, we had screened a large number of 2944 participants with carotid plaque in Tangshan Kailuan cohort study and would match two groups (Exposed group 766 participants and control group 766 participants, respectively).And then we will compare the level between exposed group and control by detecting the levels of Lp-PLA2 in carotid plaque population in Tangshan Kailuan Group. By following up the outcome of cerebrovascular disease of carotid plaque patients and proportional hazard model, we explore the effect of Lp-PLA2 on the carotid vulnerable plaque and underlying mechanism. By exploring the new inflammation biomarker of vulnerable plaque and building up the convenient and cheaper risk evaluating system for Stroke. By detecting the high risk patients and vulnerable patients, we can take preventable measures and subsequent medical treatment in primary prevention of stroke in community.

颈动脉易损斑块导致的斑块破裂、血栓形成和血管阻塞是引起急性脑卒中的主要原因。炎症免疫反应是斑块易损性最重要的内在因素之一。新型炎症因子脂蛋白磷脂酶A2（Lp-PLA2）是促进易损斑块脂质核心坏死扩大的主要原因。因此，亟待探讨其在颈动脉斑块患者卒中发病中的预警作用。本研究组在前期开滦队列研究人群筛检颈动脉斑块人群（2944例患者）的基础上，成组匹配颈动脉易损斑块组（766例）与非对照组（766例），通过检测颈动脉斑块人群Lp-PLA2水平，比较颈动脉易损斑块组与对照组Lp-PLA2水平差异；通过前瞻性队列研究，随访颈动脉斑块患者发生卒中的结局，在校正传统危险因素的基础上，研究Lp-PLA2在颈动脉易损斑块破裂发生卒中中的预警价值，最终建立经济、简单、可行的卒中预警评估体系，为早期筛检卒中高危人群、进一步个体化一级预防提供依据。

颈动脉易损斑块导致的斑块破裂、血栓形成和血管阻塞是引起急性脑卒中的主要原因。炎症免疫反应是斑块易损性最重要的内在因素之一。新型炎症因子脂蛋白磷脂酶A2（Lp-PLA2）是促进易损斑块脂质核心坏死扩大的主要原因。因此，亟待探讨其在颈动脉斑块患者卒中发病中的预警作用。本研究组在前期开滦队列研究人群筛检颈动脉斑块人群（2944例患者）的基础上，成组匹配颈动脉易损斑块组（766例）与非对照组（766例），通过检测颈动脉斑块人群Lp-PLA2水平，比较颈动脉易损斑块组与对照组Lp-PLA2水平差异；通过前瞻性队列研究，随访颈动脉斑块患者发生卒中的结局，在校正传统危险因素的基础上，研究Lp-PLA2在颈动脉易损斑块破裂发生卒中中的预警价值，最终建立经济、简单、可行的卒中预警评估体系，为早期筛检卒中高危人群、进一步个体化一级预防提供依据。. 截止到2015年12月31日，采用电话随访的方式，随访患者的5年的心脑事件结局。通过巢式病例对照研究，采用 ELLISA方法测定了2031例颈动脉斑块和对照样本的lp-PLA2 浓度。通过初步统计发现，随着lp-PLA2 浓度增加，颈动脉斑块的发生风险增加，呈现明显的剂量反应关系。随着lp-PLA2 浓度增加，颅内动脉狭窄的发生风险增加，呈现明显的剂量反应关系。结果初步表明，炎症因子与颅内动脉狭窄和颈动脉斑块的发生有关。