Jiang Junying, Gao Yuanyuan, Zhang Rui, Wang Lin, Zhao Xiaoyuan, Dai Qi, Zhang Wei, Xu Xiujian, Chen Xuemei
Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China.
Department of General Practice, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China.
Front Neurol. 2021 Mar 8;12:605372. doi: 10.3389/fneur.2021.605372. eCollection 2021.
Serum level of lipoprotein-associated phospholipase A2 (Lp-PLA2) was associated with white matter hyperintensity (WMH). There were differences in the anatomical structure and pathophysiological mechanism between periventricular WMH (PVWMH) and deep subcortical WMH (DSWMH). In this study, we aimed to investigate the effects of serum Lp-PLA2 on the PVWMH and DSWMH. In total, 711 Chinese adults aged ≥45 years with cranial magnetic resonance imaging (MRI) were recruited in this cross-sectional study, who had received physical examinations in the Department of Neurology, the Affiliated Jiangning Hospital of Nanjing Medical University due to dizziness and headaches between January 2016 and July 2019. Enzyme linked immunosorbent assay (ELISA) was utilized to determine the serum Lp-PLA2. Fazekas scale was used to measure the severity of PVWMH (grade 0-3) and DSWMH (grade 0-3) on MRI scans. Ordinal regression analysis was carried out to investigate the relationship between serum Lp-PLA2 and PVWMH or DSWMH. Finally, 567 cases were included in this study. The average level of serum Lp-PLA2 was 213.35±59.34 ng/ml. There were statistical differences in the age, hypertension, diabetes mellitus, atrial fibrillation, lacunar infarction, Lp-PLA2 grade, creatinine, Hcy, and H-CRP ( < 0.05) in PVWMH groups. Ordinal regression analysis indicated that there was a lower risk of PVWMH in the patients with normal and moderately elevated serum Lp-PLA2 compared with those with significantly elevated serum Lp-PLA2 after adjusting age, hypertension, diabetes mellitus, atrial fibrillation, lacunar infarction, Cr, Hcy, and H-CRP. In addition, PVWMH was correlated to advanced age, hypertension, diabetes mellitus, and lacunar infarction. After adjusting for confounding factors, DSWMH was correlated to advanced age and lacunar infarction. There was no correlation between serum Lp-PLA2 and DSWMH. Serum Lp-PLA2 was closely associated with the pathogenesis of PVWMH rather than DSWMH. There might be different pathological mechanisms between PVWMH and DSWMH.
血清脂蛋白相关磷脂酶A2（Lp-PLA2）水平与脑白质高信号（WMH）相关。脑室周围WMH（PVWMH）和深部皮质下WMH（DSWMH）在解剖结构和病理生理机制上存在差异。在本研究中，我们旨在探讨血清Lp-PLA2对PVWMH和DSWMH的影响。在这项横断面研究中，共纳入了711名年龄≥45岁且进行了头颅磁共振成像（MRI）检查的中国成年人，他们于2016年1月至2019年7月因头晕和头痛在南京医科大学附属江宁医院神经内科接受了体格检查。采用酶联免疫吸附测定（ELISA）法测定血清Lp-PLA2。使用Fazekas量表在MRI扫描上测量PVWMH（0-3级）和DSWMH（0-3级）的严重程度。进行有序回归分析以研究血清Lp-PLA2与PVWMH或DSWMH之间的关系。最终，本研究纳入了567例病例。血清Lp-PLA2的平均水平为213.35±59.34 ng/ml。PVWMH组在年龄、高血压、糖尿病、心房颤动、腔隙性脑梗死、Lp-PLA2分级、肌酐、同型半胱氨酸（Hcy）和高敏C反应蛋白（H-CRP）方面存在统计学差异（P<0.05）。有序回归分析表明，在调整年龄、高血压、糖尿病、心房颤动、腔隙性脑梗死、肌酐、Hcy和H-CRP后，血清Lp-PLA2正常和中度升高的患者发生PVWMH的风险低于血清Lp-PLA2显著升高的患者。此外，PVWMH与高龄、高血压、糖尿病和腔隙性脑梗死相关。在调整混杂因素后，DSWMH与高龄和腔隙性脑梗死相关。血清Lp-PLA2与DSWMH之间无相关性。血清Lp-PLA2与PVWMH的发病机制密切相关，而非DSWMH。PVWMH和DSWMH之间可能存在不同的病理机制。
