不同高敏C反应蛋白水平下脂蛋白(a)对缺血性脑卒中合并高血压人群卒中复发的影响  

Effect of lipoprotein(a)at different levels of high-sensitivity C-reactive protein on stroke recurrence in patients with ischemic stroke and hypertension

作　　者：绳芝 刘朝阳 杜艺彤 高婷 尚俊英[1] SHENG Zhi;LIU Chaoyang;DU Yitong;GAO Ting;SHANG Junying(Department of Neurology,Beijing Shijingshan Hospital,Beijing 100040,China)

机构地区：[1]北京市石景山医院神经内科,100040

出　　处：《心肺血管病杂志》2024年第4期378-383,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探索在不同hs-CRP水平下,脂蛋白(a)[Lp (a)]对缺血性脑卒中合并高血压人群卒中复发的影响。方法:本研究为回顾性队列研究,入选缺血性脑卒中合并原发性高血压患者318例。根据入院时Lp(a)的中位数将患者分为两组。研究的主要终点是1年内的卒中复发。通过多元Cox回归分析探究在整体人群及不同hs-CRP水平人群中,Lp(a)对卒中复发的影响,结果使用风险比(HR)和95%置信区间(CI)表示。结果:高Lp(a)组患者卒中复发的发生率显著增高[低Lp(a)组vs.高Lp(a)组:12, 7.6%vs. 29,18.1%,P=0.008]。调整了相关混杂因素的多元Cox回归分析的结果表明,在整体人群中,高Lp(a)组患者卒中复发(HR=2.37,95%CI:1.18-4.77,P=0.016)的风险显著升高;在高hs-CRP水平下,Lp(a)与卒中复发的风险仍显著相关(HR=2.78,95%CI:1.07~7.22,P=0.036);而低hs-CRP水平下,Lp(a)与卒中复发无显著相关性(HR=2.17,95%CI:0.71~6.63, P=0.175)。结论:在缺血性脑卒中合并原发性高血压人群中,Lp(a)与卒中复发存在显著相关性。高hs-CRP水平下,Lp(a)与卒中复发的风险同样显著相关;而低hs-CRP水平下,Lp(a)与卒中复发则无显著相关性。Objective:This study examines the influence of lipoprotein(a)[Lp(a)]on recurrent ischemic stroke among hypertensive patients,stratified by levels of hs-CRP.Methods:A retrospective cohort study was conducted involving 318 individuals diagnosed with primary hypertension and ischemic stroke.Patients were categorized based on admission Lp(a)levels into low and high Lp(a)groups.The primary outcome was the recurrence of stroke within one year.The relationship between Lp(a)levels and stroke recurrence,overall and across varying hs-CRP strata,was assessed using multivariate Cox regression models.Hazard ratios(HR)with 95%confidence intervals(CI)were reported.Results:A notable increase in stroke recurrence was observed with elevated Lp(a)levels[low Lp(a):12,7.6%vs.high Lp(a):29,18.1%;P=0.008].Multivariate Cox regression analysis revealed a significantly higher risk of stroke recurrence in the high Lp(a)group across the entire cohort(HR=2.37,95%CI:1.18-4.77,P=0.016).This association was pronounced in patients with elevated hs-CRP levels(HR=2.78,95%CI:1.07-7.22,P=0.036),but was not statistically significant in those with lower hs-CRP levels(HR=2.17,95%CI:0.71-6.63,P=0.175).Conclusions:Elevated Lp(a)levels were markedly associated with an increased risk of stroke recurrence in individuals with ischemic stroke and primary hypertension.This risk was significantly heightened in the context of high hs-CRP levels,while no significant association was observed at lower hs-CRP levels.

关 键 词：脂蛋白(a) 高敏C反应蛋白 缺血性脑卒中 原发性高血压 

分 类 号：R54[医药卫生—心血管疾病]