血清脂蛋白(a)水平与青年缺血性卒中CISS分型及严重程度的关系

罗文平; 李小玉; 骆嵩; 刘晓林

doi:10.16766/j.cnki.issn.1674-4152.001992

血清脂蛋白(a)水平与青年缺血性卒中CISS分型及严重程度的关系

doi: 10.16766/j.cnki.issn.1674-4152.001992

蚌埠医学院第一附属医院神经内科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究重点项目 KJ2019A0364

详细信息

通讯作者:
刘晓林, E-mail: sqw2408@126.com

中图分类号: R743.3
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出版历程
- 收稿日期: 2020-11-25
- 网络出版日期: 2022-02-16

Relationship between serum lipoprotein (a) level and CISS classification and severity of ischemic stroke in youth

Department of Neurology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨血清脂蛋白(a)[Lp(a)]与不同中国缺血性卒中亚型(CISS分型)青年缺血性卒中之间的关系，为其防治提供依据。方法收集蚌埠医学院第一附属医院2017年4月—2019年12月收治的122例青年缺血性卒中患者的临床资料作为青年卒中组，随机选取同期入院治疗的年龄≥45岁缺血性卒中患者122例作为中老年卒中组，比较2组传统危险因素及血清Lp(a)水平，并根据CISS分型、发病机制及NIHSS评分进行分组，比较各组间血清Lp(a)水平，采用多因素logistic分析青年缺血性卒中的独立影响因素。结果与中老年卒中组比较，青年卒中组血清Lp(a)水平明显升高，差异有统计学意义(t=7.317, P < 0.001)；不同CISS分型中，动脉粥样硬化型(LAA)、穿支动脉疾病型(PAD)、心源性卒中型(CS)、其他病因型(OE)、病因不确定型(UE)组血清Lp(a)水平分别为(381.38±62.46) mg/L、(297.94±43.97) mg/L、(283.00±39.33) mg/L、(279.25±38.22) mg/L、(292.92±34.93) mg/L，组间差异有统计学意义(F=22.772，P < 0.001)。LAA组血清Lp(a)水平显著高于PAD组、CS组、OE组及UE组，差异有统计学意义(均P < 0.05)，其余4个亚型之间比较，差异无统计学意义(均P > 0.05)；LAA组不同发病机制患者血清Lp(a)水平差异无统计学意义(F=0.264, P=0.851)；不同NIHSS评分患者血清Lp(a)水平差异有统计学意义(F=8.579, P < 0.001)；高脂血症、吸烟及Lp(a) > 300 mg/L是青年缺血性卒中LAA亚型的独立影响因素。结论血清Lp(a)升高是青年缺血性卒中的独立危险因素之一，在大动脉粥样硬化型患者中具有重要作用，可用于评估病情严重程度，应注意监测与干预。
- 缺血性卒中 /
- 青年 /
- 脂蛋白(a) /
- 中国缺血性卒中亚型
Abstract: Objective To explore the relationship between serum lipoprotein (a) [Lp(a)] and ischemic stroke in young people with different Chinese ischemic stroke subtypes (CISS classification), and provide evidence for its prevention and treatment. Methods The clinical data of 122 young patients with ischemic stroke treated in the First Affiliated Hospital of Bengbu Medical College from April 2017 to December 2019 were collected and included in the young stroke group, and 122 cases of ischemic stroke patients aged ≥ 45 years who were hospitalised during the same period were randomly admitted as the middle-aged and elderly stroke group. The traditional risk factors and serum Lp(a) levels between the two groups were compared. According to the CISS classification, pathogenesis and NIHSS scores at the time of admission, young patients with ischemic stroke were divided into different groups. The serum Lp(a) levels were compared between the groups. Multivariate logistic regression was used to analyse the independent influencing factors of ischemic stroke in young people. Results The serum Lp(a) level in the young stroke group was significantly higher than that in the middle-aged and elderly stroke group (t=7.317, P < 0.001). In different CISS classifications, serum Lp(a) levels in LAA, PAD, CS, OE, and UE groups were (381.38±62.46) mg/L, (297.94±43.97) mg/L, (283.00±39.33) mg/L, (279.25±38.22) mg/L, (292.92±34.93) mg/L, the difference between the groups was statistically significant (F=22.272, P < 0.001). The serum Lp(a) level of the LAA group was significantly higher than that of the PAD group, CS group, OE group and UE group(all P < 0.05), but there was no significant difference among the other four subtypes (all P > 0.05). Moreover, no significant difference was observed in the serum Lp(a) levels amongst patients with different pathogenesis of LAA (F=0.264, P=0.851), but a significant difference was noted in the serum Lp(a) levels amongst patients with different NIHSS scores (F=8.579, P < 0.001). Hyperlipidaemia, smoking and Lp(a)>300 mg/L were independent influencing factors of LAA subtypes in young patients with ischemic stroke. Conclusion Elevated serum Lp(a) level is one of the independent risk factors for ischemic stroke in young people. It plays an important role in patients with large atherosclerosis and can be used to assess the severity of the disease. Attention should be paid to monitoring and intervention.
- Ischemic stroke /
- Youth /
- Lipoprotein (a) /
- Chinese ischemic stroke subclassification

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表 1 青年卒中组与中老年卒中组患者基线资料比较[例(%)]

组别	例数	性别		高血压	糖尿病	高脂血症	吸烟史	饮酒史	心脏病史	卒中家族史	Lp(a) > 300 mg/L
组别	例数	男性	女性	高血压	糖尿病	高脂血症	吸烟史	饮酒史	心脏病史	卒中家族史	Lp(a) > 300 mg/L
青年卒中组	122	98(80.3)	24(19.7)	58(47.5)	31(25.4)	48(39.3)	65(53.3)	46(37.7)	12(9.8)	7(5.7)	73(59.8)
中老年卒中组	122	92(75.4)	30(24.6)	86(70.5)	45(36.9)	33(27.1)	49(40.2)	26(21.3)	42(34.4)	3(2.5)	45(36.9)
χ²值		0.856		10.386	3.746	4.158	4.215	7.881	21.404	1.668	12.886
P值		0.355		< 0.001	0.053	0.041	0.040	0.005	< 0.001	0.196	< 0.001

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表 2 青年卒中组CISS分型各亚型血清Lp(a)水平比较(x ±s，mg/L)

组别	例数	Lp(a)水平
LAA	56	381.38±62.46
PAD	32	297.94±43.97^a
CS	14	283.00±39.33^a
OE	8	279.25±38.22^a
UE	12	292.92±34.93^a
F值		22.772
P值		< 0.001
注：与LAA组比较，^aP < 0.05。

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表 3 不同发病机制缺血性卒中患者血清Lp(a)水平比较(x ±s，mg/L)

组别	例数	Lp(a)水平
动脉动脉栓塞	18	386.33±51.29
载体动脉阻塞穿支动脉	21	373.10±82.17
低灌注/栓子清除率	9	379.44±35.83
混合机制	8	394.13±51.26
F值		0.264
P值		0.851

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表 4 LAA组和非LAA组青年缺血性卒中患者危险因素比较[例(%)]

组别	例数	性别		高血压	糖尿病	高脂血症	吸烟史	饮酒史	心脏病史	卒中家族史	Lp(a) > 300 mg/L
组别	例数	男性	女性	高血压	糖尿病	高脂血症	吸烟史	饮酒史	心脏病史	卒中家族史	Lp(a) > 300 mg/L
LAA组	56	42(75.0)	14(25.0)	16(28.6)	10(17.9)	31(55.4)	37(66.1)	24(42.9)	3(5.4)	2(3.6)	45(80.4)
非LAA组	66	56(84.8)	10(15.2)	42(63.6)	21(31.8)	17(25.8)	28(42.4)	22(33.3)	9(13.6)	5(7.6)	28(42.4)
χ²值		1.859		14.936	3.115	11.122	6.806	1.170	2.342	0.898	18.139
P值		0.173		< 0.001	0.078	0.001	0.009	0.279	0.126	0.343	< 0.001

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表 5 LAA亚型危险因素多因素logistic分析

危险因素	B	SE	Wald χ²	P值	OR(95% CI)
高血压	-1.244	0.441	7.951	0.005	0.288(0.121~0.684)
高脂血症	1.174	0.450	6.787	0.009	3.233(1.337~7.818)
吸烟史	0.979	0.444	4.876	0.027	2.663(1.116~6.352)
Lp(a) > 300 mg/L	1.557	0.464	11.272	0.001	4.742(1.911~11.766)
注：因变量LAA组定义为1，非LAA组定义为0；自变量赋值，高血压，有=0，无=1；高脂血症，有=0，无=1；吸烟史，有=0，无=1；Lp(a) > 300 mg/L，是=0，否=1。

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表 6 不同NIHSS评分青年缺血性卒中患者血清Lp(a)水平比较(x ±s，mg/L)

病情程度	例数	Lp(a)水平
轻型	48	308.04±67.03^ab
中型	56	338.91±58.35^b
重型	18	379.83±75.26
F值		8.579
P值		< 0.001
注：与中型比较，^aP < 0.05；与重型比较，^bP < 0.05。

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参考文献(24)

[1]	中国脑卒中防治报告编写组. 《中国脑卒中防治报告2019》概要[J]. 中国脑血管病杂志, 2020, 17(5): 272-281. doi: 10.3969/j.issn.1672-5921.2020.05.008
[2]	HATHIDARA M Y, SAINI V, MALIK A M. Stroke in the young: A global update[J]. Curr Neurol Neurosci Rep, 2019, 19(11): 91. doi: 10.1007/s11910-019-1004-1
[3]	MCCARTY J L, LEUNG L Y, PETERSON R B, et al. Ischemic infarction in young adults: A review for radiologists[J]. Radiographics, 2019, 39(6): 1629-1648. doi: 10.1148/rg.2019190033
[4]	EKKER M S, BOOT E M, SINGHAL A B, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults[J]. Lancet Neurol, 2018, 17(9): 790-801. doi: 10.1016/S1474-4422(18)30233-3
[5]	CAPRIO F Z, SOROND F A. Cerebrovascular disease: Primary and secondary stroke prevention[J]. Med Clin North Am, 2019, 103(2): 295-308. doi: 10.1016/j.mcna.2018.10.001
[6]	ROLFS A, FAZEKAS F, GRITTNER U, et al. Acute cerebrovascular disease in the young: The stroke in young fabry patients study[J]. Stroke, 2013, 44(2): 340-349. doi: 10.1161/STROKEAHA.112.663708
[7]	SHAH N P, PAJIDIPATI N J, MCGARRAH R W, et al. Lipoprotein (a): An update on a marker of residual risk and associated clinical manifestations[J]. Am J Cardiol, 2020, 126(13): 94-102. http://www.sciencedirect.com/science/article/pii/S0002914920303325
[8]	付瀚辉, 彭斌. 脂蛋白(a)在缺血性卒中中的作用研究[J]. 中国脑血管病杂志, 2019, 16(6): 327-331. doi: 10.3969/j.issn.1672-5921.2019.06.009
[9]	彭斌, 吴波. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682. doi: 10.3760/cma.j.issn.1006-7876.2018.09.004
[10]	BOOT E, EKKER M S, PUTAALA J, et al. Ischaemic stroke in young adults: A global perspective[J]. J Neurol Neurosurg Psychiatry, 2020, 91(4): 411-417. doi: 10.1136/jnnp-2019-322424
[11]	朱琳, 姚明, 周立新, 等. 青年缺血性卒中病因诊断的性别差异研究[J]. 中风与神经疾病杂志, 2020, 37(8): 689-693. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFSJ202008005.htm
[12]	王力, 何晓芬, 王力锋, 等. 青年脑梗死患者危险因素及病因学分型分析[J]. 中国医药, 2019, 14(8): 1173-1176. doi: 10.3760/j.issn.1673-4777.2019.08.013
[13]	虞美慧, 韩丽雅, 朱丽娟, 等. 186例青年脑卒中患者临床病因及危险因素分析[J]. 中华全科医学, 2015, 13(6): 1007-1009. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201506053.htm
[14]	NAVE A H, LANGE K S, LEONARDS C O, et al. Lipoprotein (a) as a risk factor for ischemic stroke: A meta-analysis[J]. Atherosclerosis, 2015, 242(2): 496-503. doi: 10.1016/j.atherosclerosis.2015.08.021
[15]	FERRETTI G, BACCHETTI T, JOHNSTON T P, et al. Lipoprotein (a): A missing culprit in the management of athero-thrombosis?[J]. J Cell Physiol, 2018, 233(4): 2966-2981. doi: 10.1002/jcp.26050
[16]	MELLWIG K P, VOGT A. Lipoprotein (a)[J]. Clin Res Cardiol Suppl, 2019, 14(Suppl 1): 1-4.
[17]	PIRRO M, BIANCONI V, PACIULLO F, et al. Lipoprotein (a) and inflammation: A dangerous duet leading to endothelial loss of integrity[J]. Pharmacol Res, 2017, 119(5): 178-187. http://www.onacademic.com/detail/journal_1000039818731810_f28b.html
[18]	LANGSTED A, NORDESTGAARD B G, KAMSTRUP P R. Elevated lipoprotein (a) and risk of ischemic stroke[J]. J Am Coll Cardiol, 2019, 74(1): 54-66. doi: 10.1016/j.jacc.2019.03.524
[19]	GAO S, WANG Y J, XU A D, et al. Chinese ischemic stroke subclassification[J]. Front Neurol, 2011, 2(6): 1-5. http://doaj.org/article/7238bb1cb9024cdf9b295bea40552eb5
[20]	TAN S, ZHANG L, CHEN X, et al. Comparison of the Chinese ischemic stroke subclassification and Trial of Org 10172 in acute stroke treatment systems in minor stroke[J]. BMC Neurol, 2016, 16(1): 162. doi: 10.1186/s12883-016-0688-y
[21]	ZHANG H, LI Z, DAI Y, et al. Ischaemic stroke etiological classification system: The agreement analysis of CISS, SPARKLE and TOAST[J]. Stroke Vasc Neurol, 2019, 4(3): 123-128. doi: 10.1136/svn-2018-000226
[22]	郭升, 殷闯, 苏祯磊, 等. 青年缺血性脑卒中类肝素药物治疗急性缺血性脑卒中试验分型与中国缺血性卒中亚型分型比较[J]. 新乡医学院学报, 2017, 34(3): 194-196. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYX201703010.htm
[23]	冯志霞, 许哲通, 吕志坤, 等. 200例青年脑梗死患者CISS分型与高同型半胱氨酸的关系[J]. 中风与神经疾病杂志, 2016, 33(3): 242-244. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFSJ201603013.htm
[24]	陈永明, 王慧玲. 大动脉粥样硬化型脑梗死发病机制、主要危险因素及预后影响因素的研究进展[J]. 实用心脑肺血管病杂志, 2018, 26(10): 6-9. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL201810006.htm