中国人群血清脂蛋白相关磷脂酶A2与缺血性脑卒中关联性的Meta分析
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摘要
目的通过Meta分析探讨中国人群血清Lp-PLA2与缺血性脑卒中的关联性。方法计算机在线检索Pub Med,Embase,the Cochrane Library,VIP,万方,CNKI,CBM数据库,检索各数据库建立至2018年5月10日以来发布的国内外相关文献,提取数据,采用Stata12.0进行分析。结果共有8篇文献,1 431名参与者符合纳入标准。Meta分析结果显示:缺血性脑卒中患者血清Lp-PLA2水平较对照组升高,其合并标准化均数差值及其95%CI为2.34(1.59～3.09)。亚组分析发现,在高吸烟率人群中,异质性检验结果无统计学意义(I~2=0.0%,P=0.572),缺血性脑卒中患者血清LpPLA2水平与对照组相比增加,差异有统计学意义(SMD=1.90,95%CI=1.70～2.10),而在低吸烟率人群中,缺血性脑卒中患者血清Lp-PLA2水平与对照组相比无统计学差异(SMD=1.76,95%CI=0.40～3.12)。结论在中国人群中,血清Lp-PLA2的升高可能是缺血性脑卒中的重要危险因素。在缺血性脑卒中的发展过程中,吸烟可能与Lp-PLA2存在交互作用。
Objective The aim of this study was to investigate the association between Lp-PLA2 and ischemic stroke in Chinese population by meta-analysis. Methods The online search of PubMed, Embase, the Cochrane Library, Wanfang database, VIP, CNKI, and CBM was conducted. The database was searched for domestic and foreign documents published until May 10 thof 2018, and the data was extracted from studies and analyzed using Stata12.0. Results There were 8 studies and 1431 participants included. The meta-analysis showed that serum Lp-PLA2 levels in patients with ischemic stroke were higher than those in the control group, and the standardized mean difference and its 95% CI were 2.34(1.59 to 3.09). The subgroup analysis found that the heterogeneity test results were not statistically significant in the high-rate smoking population(I~2=0.0%, P=0.572). Serum Lp-PLA2 levels in patients with ischemic stroke were significantly higher than those in the control group(SMD=1.90, 95%CI=1.70-2.10), while in low-smoking populations, there was no significant difference in serum Lp-PLA2 levels between the patients with ischemic stroke and the control group(SMD =1.76, 95% CI =0.40-3.12).Conclusion In Chinese population, elevated serum Lp-PLA2 may be an important risk factor for ischemic stroke. Smoking may interact with Lp-PLA2 during the development of ischemic stroke.
Objective The aim of this study was to investigate the association between Lp-PLA2 and ischemic stroke in Chinese population by meta-analysis. Methods The online search of PubMed, Embase, the Cochrane Library, Wanfang database, VIP, CNKI, and CBM was conducted. The database was searched for domestic and foreign documents published until May 10 thof 2018, and the data was extracted from studies and analyzed using Stata12.0. Results There were 8 studies and 1431 participants included. The meta-analysis showed that serum Lp-PLA2 levels in patients with ischemic stroke were higher than those in the control group, and the standardized mean difference and its 95% CI were 2.34(1.59 to 3.09). The subgroup analysis found that the heterogeneity test results were not statistically significant in the high-rate smoking population(I~2=0.0%, P=0.572). Serum Lp-PLA2 levels in patients with ischemic stroke were significantly higher than those in the control group(SMD=1.90, 95%CI=1.70-2.10), while in low-smoking populations, there was no significant difference in serum Lp-PLA2 levels between the patients with ischemic stroke and the control group(SMD =1.76, 95% CI =0.40-3.12).Conclusion In Chinese population, elevated serum Lp-PLA2 may be an important risk factor for ischemic stroke. Smoking may interact with Lp-PLA2 during the development of ischemic stroke.
引文
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[22]龙璐,王钟明,陈贞,等.急性缺血性脑卒中患者血浆Lp-PLA2水平与颈动脉硬化斑块稳定性及神经功能缺损程度的关系[J].检验医学,2013,28(10):885-889.
[23]Katan M,Moon YP,Paik MC,et al.Lipoprotein-associated phospholipase A2 is associated with atherosclerotic stroke risk:the Northern Manhattan Study[J].PLOS One,2014,9(1):e83393.
[24]Chen CW,Lin CT,Lin YL,et al.Taiwanese female vegetarians have lower lipoprotein-associated phospholipase A2 compared with omnivores[J].Yonsei Medical Journal,2011,52(1):13-19.
[25]Cipolla MJ,Liebeskind DS,Chan SL.The importance of comorbidities in ischemic stroke:Impact of hypertension on the cerebral circulation[J].Journal of Cerebral Blood Flow and Metabolism,2018,38(12,SI):2129-2149.
[26]Wang Y,Zhang J,Qian YE,et al.Association of homocysteine with aysmptomatic intracranial and extracranial arterial stenosis in hypertension patients[J].Scientific Reports,2018,8(1):595.
[27]张世洪.Meta分析应合理设置亚组分析与敏感性分析以准确解释结果[J].中国现代神经疾病杂志,2016,16(1):1-2.
[28]唐春男.吸烟和血清脂蛋白相关磷脂酶A2水平与冠心病的研究进展[J].医学综述,2015,21(23):4272-4274.
[2]Shiber JR,Fontane E,Adewale A.Stroke registry:hemorrhagic vs ischemic strokes[J].The American Journal of Emergency Medicine,2010,28(3):331-333.
[3]Hankey GJ,Eikelboom JW.Antithrombotic drugs for patients with ischaemic stroke and transient ischaemic attack to prevent recurrent major vascular events[J].Lancet Neurology,2010,9(3):273-284.
[4]Oei HH,Van Der Meer IM,Hofman A,et al.Lipoprotein-associated phospholipase A2 activity is associated with risk of coronary heart disease and ischemic stroke:the Rotterdam Study[J].Circulation,2005,111(5):570-575.
[5]Tai W,Garcia M,Mlynash M,et al.Lipoprotein phospholipase A2mass and activity are not associated with the diagnosis of acute brain ischemia[J].Cerebrovascular Diseases,2014,38(5):324-327.
[6]Tian Y,Jia H,Li S,et al.The associations of stroke,transient ischemic attack,and/or stroke-related recurrent vascular events with Lipoprotein-associated phospholipase A2:A systematic review and meta-analysis[J].Medicine,2017,96(51):e9413.
[7]夏文翠,胡中扬,宋治.脂蛋白相关磷脂酶A2与缺血性脑卒中相关性的Meta分析[J].中南大学学报(医学版),2017,42(2):208-214.
[8]Brilakis ES,Khera A,Mcguire DK,et al.Influence of race and sex on lipoprotein-associated phospholipase A2 levels:Observations from the Dallas Heart Study[J].Atherosclerosis,2008,199(1):110-115.
[9]Wei L,Ke Z,Zhao Y,et al.The elevated lipoprotein-associated phospholipase A2 activity is associated with the occurrence and recurrence of acute cerebral infarction[J].Neuro Report,2017,28(6):325-330.
[10]王磊,章莹,费世早,等.动脉粥样硬化性脑梗死患者血浆脂蛋白相关磷脂酶A2水平及相关性研究[J].卒中与神经疾病,2011,18(3):158-161,168.
[11]林武壮,梁土金,李明海.试析血浆脂蛋白相关磷脂酶A2水平对进展性脑梗死的预测价值[J].中国医药科学,2017,7(9):233-235.
[12]朱少文,翟冬妍,张锦兰,等.血浆脂蛋白磷脂酶A2在脑梗死患者中的表达及其意义[J].中国当代医药,2016,23(10):39-41.
[13]梁江红,魏麓云,何亚丽.动脉硬化性脑梗死患者血浆LpPLA2水平及临床意义[J].实用医学杂志,2009,25(14):2264-2267.
[14]魏芳.缺血性脑卒中患者脂蛋白相关磷脂酶A2水平的变化及临床意义[J].世界最新医学信息文摘:连续型电子期刊,2015,(75):29-31.
[15]秦勇,周一心,詹青,等.Lp-PLA2与高血压患者发生缺血性脑卒中及预后的相关性分析[J].国际检验医学杂志,2018,(2):163-165.
[16]舒洪丽.脂蛋白相关性磷脂酶A2在心脑血管疾病中的临床诊断价值[D].成都中医药大学,2013.
[17]Kalanuria AA,Nyquist P,Ling G.The prevention and regression of atherosclerotic plaques:emerging treatments[J].Vascular Health and Risk Management,2012,8:549-561.
[18]Rodriguez-Colon SM,Mo J,Duan Y,et al.Metabolic syndrome clusters and the risk of incident stroke:the atherosclerosis risk in communities(ARIC)study[J].Stroke,2009,40(1):200-205.
[19]刘公理.多种生化标志物与动脉粥样硬化斑块稳定性的相关性研究[D].南方医科大学,2012.
[20]Lp-PLA(2)Studies Collaboration,Thompson A,Gao P,et al.Lipoprotein-associated phospholipase A(2)and risk of coronary disease,stroke,and mortality:collaborative analysis of 32 prospective studies[J].Lancet,2010,375(9725):1536-1544.
[21]Delgado P,Chacón P,Penalba A,et al.Lipoprotein-associated phospholipase A(2)activity is associated with large-artery atherosclerotic etiology and recurrent stroke in TIA patients[J].Cerebrovascular Diseases,2012,33(2):150-158.
[22]龙璐,王钟明,陈贞,等.急性缺血性脑卒中患者血浆Lp-PLA2水平与颈动脉硬化斑块稳定性及神经功能缺损程度的关系[J].检验医学,2013,28(10):885-889.
[23]Katan M,Moon YP,Paik MC,et al.Lipoprotein-associated phospholipase A2 is associated with atherosclerotic stroke risk:the Northern Manhattan Study[J].PLOS One,2014,9(1):e83393.
[24]Chen CW,Lin CT,Lin YL,et al.Taiwanese female vegetarians have lower lipoprotein-associated phospholipase A2 compared with omnivores[J].Yonsei Medical Journal,2011,52(1):13-19.
[25]Cipolla MJ,Liebeskind DS,Chan SL.The importance of comorbidities in ischemic stroke:Impact of hypertension on the cerebral circulation[J].Journal of Cerebral Blood Flow and Metabolism,2018,38(12,SI):2129-2149.
[26]Wang Y,Zhang J,Qian YE,et al.Association of homocysteine with aysmptomatic intracranial and extracranial arterial stenosis in hypertension patients[J].Scientific Reports,2018,8(1):595.
[27]张世洪.Meta分析应合理设置亚组分析与敏感性分析以准确解释结果[J].中国现代神经疾病杂志,2016,16(1):1-2.
[28]唐春男.吸烟和血清脂蛋白相关磷脂酶A2水平与冠心病的研究进展[J].医学综述,2015,21(23):4272-4274.