不同中医证型急性脑梗死患者血浆小而密低密度脂蛋白胆固醇、脂蛋白a表达情况与神经功能缺损和转归的关系

Relationship between small dense low-density lipoprotein cholesterol and lipoprotein(a)with the neurologic impairment and recovery in patients with acute cerebral infarction of different traditional Chinese medicine syndrome

目的研究不同中医证型急性脑梗死(ACI)患者血浆小而密低密度脂蛋白胆固醇(sdLDL-C)、脂蛋白a(Lpa)表达情况与神经功能缺损和转归的关系。方法选取120例ACI患者作为研究对象,另选取同期健康体检的志愿者120例作为对照组,比较观察组与对照组及观察组内不同中医辨证、不同预后、不同程度神经功能损伤患者血浆sdLDL-C、Lpa水平之间的差异,并对观察组血浆sdLDL-C、Lpa水平与美国国立卫生研究院卒中量表评分(NIHSS)、改良Rankin评分(mRs)评分进行相关性分析。结果观察组血浆sdLDL-C、Lpa水平高于对照组(P<0.05)。观察组不同证型患者血浆sdLDL-C、Lpa水平比较差异有统计学意义(P<0.05),血浆sdLDL-C、Lpa水平从高到低依次为风痰瘀阻型、风火上扰型、阴虚风动型。观察组不同证型患者NIHSS、mRs评分比较差异有统计学意义(P<0.05),NIHSS、mRs评分从高到低依次为风痰瘀阻型、风火上扰型、阴虚风动型。观察组预后不良的患者血浆sdLDL-C、Lpa水平高于预后良好的患者(P<0.05)。观察组不同程度神经功能损伤患者血浆sdLDL-C、Lpa水平比较差异有统计学意义(P<0.05),血浆sdLDL-C、Lpa水平从低到高依次为轻度神经功能损伤、中度神经功能损伤、重度神经功能损伤患者。相关性分析结果显示,观察组血浆sdLDL-C、Lpa水平与NIHSS、mRs评分呈现显著的负相关性(P<0.05)。结论不同中医证型ACI患者血浆sdLDL-C、Lpa表达呈现显著的差异,血浆sdLDL-C、Lpa与神经功能缺损和转归呈现显著的负相关性,sdLDL-C、Lpa水平越高,预后越差。

Objective To investigate the relationship between the expression of small dense low-density lipoprotein cholesterol(sdLDL-C)and lipoprotein(a)(Lp[a])with the neurologic impairment and recovery in patients with acute cerebral infarction(ACI)of different traditional Chinese medicine(TCM)syndrome.Methods Totally 120 ACI patients and 120 healthy physical examination volunteers in the same period were selected as the observation group and the control group,respectively.The differences in sdLDL-C and Lp(a)among ACI patients with different TCM syndrome,different prognosis,and different neurologic impairment were compared.The correlation between plasma sdLDL-C,Lp(a)and National Institutes of Health Stroke Scale(NIHSS),modified Rankin scale(mRS)was analyzed.Results The plasma sdLDL-C and Lp(a)levels in observation group were significantly higher than those in control group(P<0.05).There were statistically significant differences in sdLDL-C,Lp(a),NIHSS and mRs scores in patients with different TCM syndrome(all P<0.05).The sdLDL-C,Lp(a),NIHSS and mRs scores of patients with different TCM syndrome from high to low were phlegm wind resistance type,wind-fire ascending syndrome and Yin deficiency wind-moving type.The plasma levels of sdLDL-C and Lp(a)in patients with poor prognosis were significantly higher than those in patients with good prognosis(P<0.05).The difference was statistically significant in plasma sdLDL-C and Lp(a)levels in patients with different neurologic impairment of the observation group(P<0.05).The plasma sdLDL-C and Lp(a)levels of patients with different neurologic impairment from low to high were mild,moderate and severe neurologic impairment.The correlation analysis showed that plasma sdLDL-C and Lp(a)levels were significantly correlated with NIHSS and mRs scores in the observation group(P<0.05).Conclusion The expressions of plasma sdLDL-C and Lp(a)in ACI patients with different TCM syndrome were significantly different,and the plasma sdLDL-C and Lp(a)levels in the body were significantly correlated with neurologic impairment and recovery.The higher the plasma sdLDL-C and Lp(a),the worse the prognosis.