急性脑梗死患者颈动脉粥样硬化斑块形成严重程度与血脂水平的关系

Research on the relationship between hyperlipemia and carotid atherosclerosis of patients with acute cerebral infarction

目的探讨急性脑梗死患者颈动脉粥样硬化斑块严重程度与血脂水平的关系。方法 253例急性脑梗死患者,根据颈动脉彩色多普勒超声检查结果分为无斑块组、内膜增厚组、轻度狭窄组、中度狭窄组及重度狭窄-闭塞组。检测患者血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、脂蛋白(LP)(a)、载脂蛋白(Apo)A-Ⅰ及(Apo)B水平。比较各组患者脂蛋白、载脂蛋白及各血脂水平的差异,分析各组颈动脉粥样硬化斑块形成严重程度与脂蛋白、载脂蛋白及各血脂水平之间的相关性。结果组间比较各组患者血清TC、LDL-C、LP(a)、ApoB、ApoA-Ⅰ及ApoB/ApoA-Ⅰ水平比较,差异有统计学意义(P<0.05)。血清TC、LDL-C、LP(a)、ApoB、ApoB/ApoA-Ⅰ水平与颈动脉狭窄呈正相关。(r=0.15,P<0.05,r=0.24,r=0.29,r=0.37,r=0.50,P<0.01),血清ApoA-Ⅰ水平与颈动脉狭窄程度呈负相关(r=-0.21,P<0.01)。逐步回归分析显示,TC、ApoB/ApoA-Ⅰ水平与急性脑梗死患者颈动脉狭窄呈正相关(P<0.05)。结论急性脑梗死患者的颈动脉狭窄程度与血清TC、ApoB/ApoA-Ⅰ水平密切相关。ApoB/ApoA-Ⅰ水平是预测缺血性脑卒中的重要危险因素。

Objective To explore the relationship between hyperlipemia,lipoprotein （LP） （a）,apolipoproteins （ApoA-Ⅰ And ApoB）,the ratio of ApoB/ApoA-Ⅰ and carotid atherosclerotic progression in patients with acute cerebral infarction.Methods 253 patients with acute cerebral infarction were divided into 5 groups according to carotid duplex ultrasound outcomes.The serun levels of total cholesterol （TC）,triglycerides （TG）,high-density lipoprotein cholesterol （HDL-C）,low-density lipoprotein cholesterol （LDL-C）,LP （a）,and apolipoproteins （ApoA-Ⅰ and ApoB） were assessed.To compare the serum levels of lipids,LP （a） and apolipoproteins between groups,and to analyze the correlation of coratid atherosclerotic plaque and stenosis severity with serum levels of lipids and LP （a） and apolipoproteins.Results The serum levels of TC、LDL-C、LP （a）、ApoB、ApoA-Ⅰ and ApoB/ApoA-Ⅰ in 5 groups of acute cerebral infarction were significant difference（P＜ 0.05）.The serum TC、LDL-C、LP （a）、ApoB、ApoB/ApoA-Ⅰ levels were positively related with the severity of carotid stenosis（r=0.15,P＜0.05;r=0.24,r=0.29,r=0.37,r=0.50,P＜0.01）,whereas the serum ApoA-Ⅰ level was negatively ralated with the significantly severity of carotid stenosis（r =-0.21,P＜0.01）.In Logistic regression,serum TC level and ApoB/ApoA-Ⅰ ratio were significantly related to the severity of carotid stenosis after adjusted for age and sex（P＜0.01）.Conclusion The serum TC level and ApoB/ApoA-Ⅰ ratio were closely related with the severity of carotid stenosis in acute cerebral infarction patients.ApoB/ApoA-Ⅰ ratio was an important risk factor for predicting ischemic stroke.