老年颈动脉狭窄患者脂蛋白(a)与颈动脉斑块内新生血管的关系  

Relationship between plasma Lp(a) and carotid intraplaque neovascularization in elderly carotid stenosis patients

作　　者：丘伟达 夏爽 徐兰 吴泽佳 黎励文[1] Qiu Weida;Xia Shuang;Xu Lan;Wu Zejia;Li Liwen(Department of Cardiology,Guangdong Provincial People's Hospital,Guangdong Institute of Cardiovascular Diseases,Guangzhou 510100,Guangdong Province,China)

机构地区：[1]广东省人民医院广东省心血管病研究所心血管内科,广州510100 [2]南方医科大学第二临床学院临床医学系

出　　处：《中华老年心脑血管病杂志》2021年第12期1304-1308,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：广东省医学科学技术研究基金(A2017293)。

摘　　要：目的分析老年颈动脉狭窄患者血浆脂蛋白(a)[Lp(a)]水平与颈动脉超声造影(CEUS)检查斑块内新生血管(IPN)评分的关系。方法选择年龄≥60岁的颈动脉狭窄患者172例,根据CEUS检查IPN评分分为稳定斑块组98例(IPN评分<2分)和不稳定斑块组74例(IPN评分≥2分)。同时还将患者分为Lp(a)≥300 mg/L组49例和Lp(a)<300 mg/L组123例。回顾性分析入选患者的临床基线资料,采用肯德尔相关性分析、单因素及多因素二元logistic回归分析。结果与稳定斑块组比较,不稳定斑块组颈内动脉斑块最大厚度及总厚度更高(P<0.05)。与Lp(a)<300 mg/L组比较,Lp(a)≥300 mg/L组HDL-C水平、颈内动脉重度狭窄及脑动脉缺血比例更高(P<0.05,P<0.01)。血浆Lp(a)水平与颈内动脉斑块最大厚度、斑块总厚度、狭窄程度和闭塞均不相关(P>0.05)。单因素logistic回归分析中,血浆Lp(a)水平可预测老年颈内动脉狭窄患者IPN(OR=1.284,P=0.002);与Lp(a)<300 mg/L患者比较,Lp(a)≥300 mg/L患者双侧颈内动脉IPN评分≥2分的风险升高2.232倍(OR=2.232,P=0.019)。多因素logistic回归分析校正相关协变量后,Lp(a)水平每升高100 mg/L,双侧颈内动脉IPN评分≥2分的风险升高1.360倍(OR=1.360,P=0.001);与Lp(a)<300 mg/L患者比较,Lp(a)≥300 mg/L患者双侧颈内动脉IPN评分≥2分的风险升高3.376倍(OR=3.376,P=0.008)。结论老年颈动脉狭窄患者中,颈动脉IPN评分与血浆Lp(a)水平独立相关,血浆Lp(a)是颈动脉斑块稳定的独立危险因素。Objective To analyze the relationship between plasma Lp(a) and carotid IPN in elderly carotid stenosis patients.Methods One hundred and seventy-two ≥60 years old carotid stenosis patients admitted to our hospital from January 2017 to January 2020 were divided into stable plaque group(n=98) and unstable plaque group(n=70) according to their carotid IPN score and into plasma Lp(a)≥300 mg/L group(n=49) and plasma Lp(a)<300 mg/L group(n=123).Their baseline clinical data were recorded by retrospective analysis and analyzed by Kendell correlation analysis, univariate logistic regression analysis and multivariate logistic regression analysis respectively.Results The maximal thickness and total thickness of carotid intraplaques were significantly thicker in unstable plaque group than in stable plaque group(P<0.05).The serum HDL-C level and incidence of severe internal carotid stenosis and cerebral ischemia were significantly higher in plasma Lp(a)≥300 mg/L group than in plasma Lp(a)<300 mg/L group(P<0.05,P<0.01).The plasma Lp(a) was not related with the maximal thickness and total thickness of carotid intraplaques, severity of carotid stenosis and occlusion(P>0.05).Univariate logistic regression analysis showed that plasma Lp(a) could predict the carotid IPN in elderly internal carotid stenosis patients(OR=1.284,P=0.002).The risk of bilateral carotid IPN score ≥2 was 2.232-fold higher in plasma Lp(a) ≥300 mg/L group than in plasma Lp(a) <300 mg/L group(OR=2.232,P=0.019).Multivariate logistic regression analysis displayed that the risk of bilateral carotid IPN score ≥2 was 1.360-fold higher when the plasma Lp(a) increased per 100 mg/L(OR=1.360,P=0.001),and 3.376-fold higher in plasma Lp(a) ≥300 mg/L group than in plasma Lp(a)<300 mg/L group(OR=2.232,P=0.019).Conclusion The carotid IPN score is independently associated with the plasma Lp(a),and plasma Lp(a) is an independent risk factor for stable carotid plaques in elderly carotid stenosis patients.

关 键 词：颈动脉狭窄 脂蛋白(A) 斑块 动脉粥样硬化 超声检查 血管造影术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]