Relationship between serum lipoprotein-associated phospholipase A2,homocysteine levels and disease severity and prognosis in elderly hypertensive patients with acute cerebral infarction

Ling Weihan; Peng Xiaolian; Zhong Wei; Shi Yuliang; Chen Danxia; Feng Miaoling; Chen Lifen

doi:10.11986/j.issn.1673-873X.2025.05.05

Abstract：Objective To investigate the relationship between serum lipoprotein-associated phospholipase A2(Lp-PLA2)and homocysteine(Hcy)levels with disease severity and prognosis in elderly hypertensive patients with acute cerebral infarction(ACI),and to provide clinical reference for treatment.Methods From January 2020 to December 2023,136 elderly hyperten-sive patients with ACI admitted to Meizhou People's Hospital were enrolled.Based on National Institutes of Health Stroke Scale(NIHSS)scores,patients were assigned to a mild infarction group(NIHSS ≤4,n=83)and a moderate infarction group(NIHSS 5-20,n=53).According to modified Rankin Scale(mRS)scores at 90 days postonset,patients were further catego-rized into a poor-outcome group(n=24)and a good-outcome group(n=112).Pearson correlation analysis was used to exam-ine associations between serum Lp-PLA2,Hcy,and NIHSS scores.Receiver operating characteristic(ROC)curves were a-dopted to assess the predictive value of Lp-PLA2 and Hcy for patient outcomes.Multivariate logistic regression was employed to identify factors influencing prognosis.Results The mild infarction group had significantly lower serum Lp-PLA2 and Hcy levels and NIHSS scores than the moderate infarction group(P＜0.05).Both Lp-PLA2 and Hcy levels correlated positively with NIHSS scores(P＜0.05).Patients in the good-outcome group exhibited significantly lower Lp-PLA2 and Hcy levels compared to those in the poor-outcome group(P＜0.05).The area under the ROC curve(AUC)for predicting outcome was 0.835(95％CI:0.780-0.890)for Lp-PLA2 and 0.782(95％CI:0.737-0.827)for Hcy;combined,the AUC rose to 0.905(95％CI:0.860-0.955).Compared with the poor-outcome group,the good-outcome group also had significantly lower sys-tolic blood pressure,and lowdensity lipoprotein cholesterol(LDL-C)(P＜0.05).Multivariate logistic regression revealed that systolic blood pressure(OR=2.228,95％CI:1.209-4.106),Lp-PLA2(OR=2.849,95％CI:1.564-5.190),and Hcy(OR=2.385,95％CI:1.394-4.080)were influencing factors of prognosis(P＜0.05).Conclusion Serum Lp-PLA2 and Hcy levels are closely associated with disease severity and prognosis in elderly hypertensive patients with ACI and may serve as potential prognostic biomarkers.