标题：H型高血压合并AIS患者外周血ApoB、Apelin-13与颈动脉斑块、预后的相关性

      作者：赵志林 1，任旭爱 1，王秋锋 1，卞妮娜 1，伏晓琳 2    赵志林 1，任旭爱 1，王秋锋 1，卞妮娜 1，伏晓琳 21.咸阳市第一人民医院心内科，陕西 咸阳 712000；2.咸阳市中心医院重症医学科，陕西 咸阳 712000

      卷次： 2023年34卷20期

      【摘要】 目的 探讨H型高血压合并急性缺血性脑卒中(AIS)患者外周血载脂蛋白B (ApoB)、孤独G蛋白偶联受体配体13 (Apelin-13)与颈动脉斑块、预后的相关性。方法 选取2020年4月至2022年6月咸阳市第一人民医院收治的121例H型高血压合并AIS患者纳入AIS组，根据超声诊断仪颈动脉斑块检测结果，将97例斑块形成者纳入斑块形成组(易损斑块 78例，稳定斑块19例)，24例无斑块形成者纳入无斑块形成组；根据患者发病后3个月改良Rankin量表(mRS)评分结果，将72例mRS评分≤2分者纳入预后良好组，49例>2分者纳入预后不良组。另选取同期120例H型高血压未合并AIS患者纳入非AIS组，检测所有患者外周血ApoB、Apelin-13水平，比较不同组别患者外周血ApoB、Apelin-13水平的差异，采用Logistic回归分析H型高血压合并AIS患者颈动脉斑块形成影响因素，通过受试者工作曲线(ROC)分析外周血指标对H型高血压合并AIS患者预后的评估价值。结果 AIS组患者的外周血ApoB表达水平为(1.25±0.38) g/L，明显高于非AIS组的(0.96±0.19) g/L，Apelin-13水平为(24.39±4.11) ng/mL，明显低于非AIS组的(32.26±3.06) ng/mL，差异均有统计学意义(P<0.05)；AIS组中颈动脉斑块形成患者外周血ApoB水平为(1.29±0.19) g/L，明显高于斑块未形成者的(1.09±0.17) g/L，Apelin-13水平为(23.89±3.18) ng/mL，明显低于斑块未形成者的(26.42±3.36) ng/mL，差异均有统计学意义(P<0.05)；经Logistic回归分析结果显示，高龄、外周血ApoB高表达是颈动脉斑块形成的独立危险因素(P<0.05)，Apelin-13高表达是颈动脉斑块未形成的保护因素(P<0.05)；AIS组颈动脉斑块形成者中，易损斑块者外周血ApoB表达水平为(1.32±0.19) g/L，明显高于稳定斑块者的(1.18±0.15) g/L，Apelin-13表达水平为(23.57±3.04) ng/mL，明显低于稳定斑块者的(25.22±2.68) ng/mL，差异均有统计学意义(P<0.05)；AIS组预后良好者的外周血ApoB表达水平为(1.19±0.27) g/L，明显低于预后不良者的(1.34±0.31) g/L，Apelin-13表达水平为(25.90±2.60) ng/mL，明显高于预后不良者的(22.17±2.77) ng/mL，差异均有统计学意义(P<0.05)；经ROC曲线分析结果显示，外周血ApoB、Apelin-13水平联合检测评估患者预后不良曲线下面积(AUC)为0.827，显著高于两项指标单独检测曲线下面积的 0.692、0.754 (P<0.05)。结论 H型高血压合并AIS患者外周血ApoB水平增加，Apelin-13水平降低，且其表达水平与患者颈动脉斑块形成相关；ApoB高表达、Apelin-13低表达预示患者预后不良。
      【关键词】 H型高血压；急性缺血性脑卒中；颈动脉斑块；载脂蛋白B；孤独G蛋白偶联受体配体13；预后；相关性
      【中图分类号】 R544.1 【文献标识码】 A 【文章编号】 1003—6350（2023）20—2906—05

Correlation between peripheral blood ApoB, Apelin-13 and carotid plaques, prognosis in patients with H-typehypertension and acute ischemic stroke.
ZHAO Zhi-lin 1, REN Xu-ai 1, WANG Qiu-feng 1, BIAN Ni-na 1, FU Xiao-lin 2.1. Department of Cardiology, Xianyang First People's Hospital, Xianyang 712000, Shaanxi, CHINA; 2. Department ofCritical Care Medicine, Xianyang Central Hospital, Xianyang 712000, Shaanxi, CHINA
【Abstract】 Objective To explore the correlation between peripheral blood apolipoprotein B (ApoB), solitaryG protein-coupled receptor ligand-13 (Apelin-13) and carotid plaques, prognosis in patients with H-type hypertensionand acute ischemic stroke (AIS). Methods A total of 121 patients with H-type hypertension and AIS admitted to Xian-yang First People's Hospital were included in AIS group between April 2020 and June 2022. According to detection re-sults of carotid plaques by diasonograph, they were divided into patients with carotid plaques formation (97 cases, includ-ing 78 cases with vulnerable plaques and 19 cases with stable plaques) and patients without carotid plaques formation(24 cases). According to scores of modified Rankin Scale (mRS) at 3 months after the onset, they were divided into goodprognosis group (n=72, ≤2 points) and poor prognosis group (n=49, >2 scores). A total of 120 H-type hypertension pa-tients without AIS during the same period were included in non-AIS group. The levels of peripheral blood ApoB andApelin-13 in all patients were detected and compared among different groups. The influencing factors of carotidplaque formation were analyzed by Logistic regression analysis. The evaluation value of peripheral blood indexes forprognosis of patients with H-type hypertension and AIS was analyzed by receiver operating characteristic (ROC)curves. Results The expression level of peripheral blood ApoB in AIS group was significantly higher than that innon-AIS group [(1.25±0.38) g/L vs (0.96±0.19) g/L], while Apelin-13 level was significantly lower than that in non-AISgroup [(24.39±4.11) ng/mL vs (32.26±3.06) ng/mL], with statistically significant differences (P<0.05). In AIS group,ApoB level in patients with carotid plaques formation was significantly higher than that in patients without carotidplaques formation [(1.29±0.19) g/L vs (1.09±0.17) g/L], while Apelin-13 level was significantly lower than that in pa-tients without carotid plaques formation [(23.89±3.18) ng/mL vs (26.42±3.36) ng/mL], with statistically significant differ-ences (P<0.05). The results of Logistic regression analysis showed that advanced age and high expression of ApoB wereindependent risk factors of carotid plaques formation (P<0.05), while high expression of Apelin-13 was a protective fac-tor of non-formation (P<0.05). In patients with carotid plaques formation, expression level of ApoB in patients with vul-nerable plaques was significantly higher than that in patients with stable plaques [(1.32±0.19) g/L vs (1.18±0.15) g/L],while Apelin-13 level was significantly lower than that in patients with stable plaques [(23.57±3.04) ng/mL vs (25.22±2.68) ng/mL], with statistically significant differences (P<0.05). In AIS group, ApoB level in patients with good prognosiswas significantly lower than that in patients with poor prognosis [(1.19±0.27) g/L vs (1.34±0.31) g/L], while Apelin-13level was significantly higher than that in patients with poor prognosis [(25.90±2.60) ng/mL vs (22.17±2.77) ng/mL], withstatistically significant differences (P<0.05). ROC curves analysis showed that area under ROC curve (AUC) of ApoBcombined with Apelin-13 for evaluating poor prognosis was 0.827, significantly greater than that of the two indexesalone (0.692, 0.754, P<0.05). Conclusion The level of peripheral blood ApoB increases and Apelin-13 level decreasesin patients with H-type hypertension and AIS. The two indexes are correlated with the formation of carotid plaques. Highexpression of ApoB and low expression of Apelin-13 indicate poor prognosis.
      【Key words】 H-type hypertension; Acute ischemic stroke; Carotid plaque; Apolipoprotein B; Solitary G pro-tein-coupled receptor ligand-13; Prognosis; Correlation