缺血性卒中CISS亚型与Lp(a)水平相关性分析

Analysis of the relationship of level of Lp(a) between Chinese ischemic stroke subclassification

目的分析急性缺血性卒中患者Lp(a)水平及其与中国缺血性卒中亚型的关系。方法收集200例急性缺血性卒中患者作为病例组,136例非脑血管疾病患者作为对照组,按照CISS分型标准将缺血性卒中患者分为5类。检测其清晨空腹血血脂各项指标,包括总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、Lp(a)等,应用统计学方法分析CISS亚型与上述血脂指标水平的关系。结果 (1)缺血性卒中组患者及大动脉粥样硬化性、穿支动脉疾病亚组患者Lp(a)水平高于对照组,差异具有统计学意义(P<0.05);(2)心源性卒中与穿支动脉疾病亚组Lp(a)水平低于大动脉粥样硬化性亚组,差异具有统计学意义(P<0.01);(3)Logistic回归分析结果显示,Lp(a)水平与缺血性卒中发生有关(OR=1.011,P=0.009);与大动脉粥样硬化性脑卒中的发生相关(OR=1.020,P<0.001)。结论 Lp(a)水平升高是缺血性卒中的独立危险因素,与大动脉粥样硬化性脑卒中关系最为密切;高水平的Lp(a)可能是降脂治疗后大动脉粥样硬化性脑卒中血脂相关剩余风险之一。

Objective To analyze the relationship of level of Lp（a） and Chinese ischemic stroke sub-classification. Methods 200 patients with acute ischemic stroke in our department were recruited as patients group. 136 patients without cerebrovascular disease were enrolled as control group. The patients group were distributed to five subgroups according to Chinese ischemic stroke sub-classification criteria based on the examination results. The level of serum lipids of all the patients were measured. Results（1） The level of Lp（a） of patients group, large artery atherosclerotic（LAA） subgroup and penetrating artery disease（PAD） subgroup were significant higher than those of control group（P〈0.05）.（2） Compared with patients of large artery atherosclerotic（LAA） subgroup, patients of cardioembolic stroke（CS） subgroup and PAD subgroup had a much lower level of Lp（a）（P〈0.01）.（3） Logistic regression analysis results showed that the level of Lp（a） had significant correlation with ischemic stroke（OR=1.011, P=0.009）. The level of Lp（a） was correlated with patients with LAA（OR=1.020, P〈0.001）. Conclusion Lp（a） is an independent risk factor for ischemic stroke. And it has the closest correlation with large artery atherosclerotic stroke. High levels of Lp（a） may be one of the risk remaining lipid-lowering therapy of large artery atherosclerotic stroke.