Zhongguo cuzhong zazhi (May 2024)
脂蛋白（a）与颈动脉粥样硬化不稳定斑块的关系 Relationship between Lipoprotein(a) and Unstable Carotid Atherosclerotic Plaque
Abstract
摘要： 目的 探讨血清脂蛋白（a）[lipoprotein(a)，Lp(a)]水平与颈动脉粥样硬化不稳定斑块的关系。 方法 回顾性连续纳入2022年1—12月在首都医科大学附属北京朝阳医院神经内科住院的缺血性脑血管病（包括缺血性卒中、TIA和慢性脑缺血）患者，所有患者均进行了Lp(a)检测及颈动脉超声检查。根据颈动脉超声的斑块回声特征将患者分为不稳定斑块组和稳定斑块组，以Lp(a)正常范围上限（30 mg/dL）为界值，采用多因素logistic回归分析Lp(a)升高对颈动脉粥样硬化不稳定斑块的影响。此外，以LDL-C水平1.8 mmol/L为界值，分析不同LDL-C水平下，Lp(a)对颈动脉粥样硬化不稳定斑块的影响。 结果 研究共纳入747例患者，中位年龄为66（58～72）岁，其中男性484例（64.8%）。单因素分析结果显示不稳定斑块组患者年龄更大，男性以及有高血压、糖尿病和卒中病史者所占比例更高，Lp(a)、Hcy和糖化血红蛋白水平更高。多因素logistic回归分析显示，Lp(a)升高是颈动脉粥样硬化不稳定斑块的独立危险因素（OR 1.65，95%CI 1.02～2.68，P=0.04）。亚组分析发现，LDL-C＜1.8 mmol/L时Lp(a)对颈动脉粥样硬化不稳定斑块的影响无统计学意义（OR 1.41，95%CI 0.34～5.93），但LDL-C和Lp(a)水平对颈动脉粥样硬化不稳定斑块无交互作用。 结论 Lp(a)升高与颈动脉粥样硬化不稳定斑块相关，但在低LDL-C水平下，Lp(a)升高对颈动脉粥样硬化不稳定斑块的影响无统计学意义。 Abstract: Objective To investigate the relationship between lipoprotein(a) [Lp(a)] and unstable carotid atherosclerotic plaque. Methods Patients with ischemic cerebrovascular disease (including ischemic stroke, TIA and chronic cerebral ischemia) who were hospitalized in the Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University from January to December 2022 were retrospectively included. All patients completed Lp(a) test and carotid ultrasound examination. According to the plaque echo characteristics of carotid ultrasound, the patients were divided into unstable plaque group and stable plaque group. The upper limit of normal Lp(a) level (30 mg/dL) was selected as the critical value. Multivariate logistic regression was used to analyze the effect of elevated Lp(a) level on unstable carotid atherosclerotic plaque. In addition, the effect of Lp(a) on unstable carotid atherosclerotic plaque at different levels of LDL-C was analyzed with LDL-C level of 1.8 mmol/L as the critical value. Results A total of 747 eligible patients were enrolled in this study, including 484 males (64.8%), with a median age of 66 (58-72) years. Univariate analysis showed that patients in the unstable plaque group was older, with higher proportions of male, history of hypertension, diabetes mellitus and stroke, and higher levels of Lp(a), Hcy and glycosylated hemoglobin. Multivariate logistic regression analysis showed that elevated Lp(a) was an independent risk factor of unstable carotid atherosclerotic plaque (OR 1.65, 95%CI 1.02-2.68, P=0.04). Subgroup analysis showed that Lp(a) had no significant effect on unstable carotid atherosclerotic plaque when LDL-C<1.8 mmol/L (OR 1.41, 95%CI 0.34-5.93), but there was no interaction between the LDL-C and Lp(a) levels on unstable carotid atherosclerotic plaque. Conclusions Elevated Lp(a) was associated with unstable carotid atherosclerotic plaque. However, at low LDL-C levels, the effect of elevated Lp(a) on unstable carotid atherosclerotic plaque was not significant.
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