血清脂蛋白（a）与缺血性卒中及其病因学亚型的相关性

Correlations of serum lipoprotein （a） with ischemic stroke and its etiological subtypes

目的探讨血清脂蛋白（a）[lipoprotein（a），Lp（a）]水平与急性缺血性卒中及其病因学亚型的相关性。方法回顾性纳入连续的急性缺血性卒中住院患者（病例组）以及年龄和性别相匹配的同期健康体检者（对照组）。收集病例组和对照组人口统计学和基线临床资料以及空腹血糖、纤维蛋白原、高半胱氨酸、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、Lp（a）浓度。病例组根据TOAST病因学分型标准分为大动脉粥样硬化（large artery atherosclerosis，LAA）、小动脉闭塞（small artery occlusion，SAO）、心源性栓塞（cardinembolism，CE），并排除其他明确病因和病因不明的患者。对病例组和对照组人口统计学和基线临床资料进行比较，并采用多变量logistic回归分析明确血清Lp（a）与急性缺血性卒中及其病因学分型的相关性。结果共纳入214例缺血性卒中组患者，其中LAA97例（45．33％），SAO64例（29．91％），CE53例（24．77％）；对照组118例。病例组高血压、糖尿病、高脂血症、心房颤动和饮酒的比例以及收缩压、舒张压、空腹血糖、总胆固醇、低密度脂蛋白胆固醇、Lp（a）、纤维蛋白原、高半胱氨酸水平与对照组存在统计学差异（P均〈0．001）。多变量如加疵回归分析显示，校正年龄和性别后，Lp（a）是缺血性卒中的独立危险因素[优势比（odds ratio，OR）2．014，95％可信区间（confidence interval，CI）1．273～3．092；P=0．036]；LAA的独立危险因素包括高血压（OR3．353，95％CI1．714～6．558；P〈0．001）、收缩压（OR2．786，95％CI1．136～5．538；P=0．016）、高半胱氨酸（OR1．108，95％CI1．031—2．191；P=0．005）、总胆固醇（OR2．169，95％CI1．599～4．943；P〈0．001）、低密度脂蛋白胆固醇（OR2．782，95％CI1．093～5．238；P=0．024）和Lp（a）（0R3．072，95％CI1．907～8．064；P=0．001），SAO的独立危险因素包括高血压（OR7．042，95％CI3，189～25．55；P〈0．001）、糖尿病（OR5．162，95％CI2．372～11．23；P〈0．001）、纤维蛋白原（OR1．667，95％CO1．434～2．025；P=0．045）和高半胱氨酸（OR1．967，95％CI1．859～1．995；P=0．036），CE的独立危险因素包括心房颤动（OR13．340，95％CI4．637～39．20；P〈0．001）、纤维蛋白原（OR2．365，95％CI1．147～4．904；P=0．029）和Lp（a）（OR1．656，95％CI1．996～3．001；P=0．035）。结论Lp（a）是缺血性卒中的独立危险因素，可作为预测缺血性卒中发病风险的血清生物学标记物。不同卒中病因学亚型之间的独立危险因素存在差异，Lp（a）与LAA和CE独立相关，但与SAO无独立性相关性。

Objeetive To investigate the correlation between serum lipoprotein （a） （Lp（a）） level and ischemic stroke and its etiological subtypes. Methods The consecutive inpatients with acute ischemic stroke （case group） and age-and sex-matched healthy subjects （control group） over the same period were enrolled retrospectively. The demographic and baseline clinical data, as well as fasting blood glucose, fibrinogen,homocysteine, total cholesterol, triacylglycerol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and Lp（a） concentration of the case group and the control group were collected. According to TOAST classification criteria, the patients in the case group were divided into large artery atherosclerosis （LAA）, small artery occlusion （SAO） and cardioembolism （CE）, and the patients with other determined etiology and undetermined etiology were excluded. Multivariate logistic regression analysis was used to make clear the correlation between serum Lp（a） and acute ischemic stroke and its etiological subtypes. Results A total of 214 patients with ischemic stroke were enrolled. Ninety-seven had LAA （45.33%）, 64 （29. 91%） had SAO, and 53 （24. 77%） had CE. There were 118 subjects in the control group. There were significant differences in the proportions of hypertension, diabetes, hyperlipidemia, atrial fibrillation and alcohol consumption, as well as systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, Lp（a）, fibrinogen, and bomocysteine between the case group and the control group （all P 〈0. 001）. Multivariate logistic regression analysis showed that after adjustment for age and sex, Lp（a） is an independent risk factor for ischemic stroke （odds ratio [ OR] 2. 014, 95% confidence interval [ CI] 1.273-3.092, P= 0.036）. The independent risk factors for LAA included hypertension （OR 3. 353, 95% CI 1. 714-6. 558, P=0. 001）, systolic blood pressure （OR 2. 786, 95% CI 1. 136-5. 538, P=0. 016）, homocysteine （OR 1. 108, 95% CI 1. 031-2. 191, P=0. 005）, total cholesterol （OR 2. 169,95% CI 1. 599-4. 943, P = 0. 001）, low-density lipoprotein cholesterol （OR 2. 782, 95% CI1. 093-5.238, P=0. 024）, and Lp（a） （OR 3.072, 95% CI 1. 907-8. 064, P=0. 001）. The independent risk factors for SAO included hypertension （OR 7. 042, 95% CI3. 189-25.55, P=0. 001）, diabetes mellitus （OR 5. 162, 95% CI2. 372-11.23, P =0. 001）, fibrinogen （OR 1. 667, 95% CI 1. 434-2. 025, P =0. 045）, and homocysteine （OR 1. 967, 95% CI 1. 859-1. 995, P =0. 036）. The independent risk factors for CE included atrial fibrillation （OR 13. 340, 95% CI 4. 637-39. 20, P=0. 001）, fibrinogen （OR 2. 365, 95% CI 1. 147- 4.904, P=0.029）, and Lp（a） （OR 1.656, 95% CI 1.996-3.001, P=0.035）. Conelusions Lp（a） is an independent risk factor for ischemic stroke, and can be used as a serum biomarker for predicting the risk of the onset of ischemic stroke. There are differences in independent risk factors between the different stroke etiological subtypes, Lp（a） is independently associated with LAA and CE; however, it has no independent correlation with SAO.