急性脑梗死患者小而密低密度脂蛋白及脂蛋白(a)水平与颈动脉斑块稳定性的相关性分析  

Correlation of small dense low-density lipoprotein and lipoprotein(a)with carotid plaque stability in patients with acute cerebral infarction

作　　者：郝烘玉[1] 邢星[1] 褚红珊 段瑞生[1] Hao Hongyu;Xing Xing;Chu Hongshan;Duan Ruisheng(Department of Neurology,Hebei Provincial People's Hospital,Shijiazhuang 050o00,Hebei Province,China)

机构地区：[1]河北省人民医院神经内科,石家庄050000

出　　处：《中华老年心脑血管病杂志》2025年第3期327-331,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河北省2020年度医学科学研究课题项目(20200022)。

摘　　要：目的分析急性脑梗死(acute cerebral infarction,ACI)患者小而密低密度脂蛋白(small dense low-density lipoprotein,sd-LDL)及脂蛋白(a)水平与颈动脉斑块稳定性的关系。方法回顾性选取2020年2月至2024年2月河北省人民医院收治的老年ACI患者160例,所有患者行颈部彩色多普勒超声检查,依据颈动脉斑块情况分为无斑块组43例、稳定斑块组56例和不稳定斑块组61例,另取同期河北省人民医院健康体检者40例作为对照组,比较4组临床资料、sd-LDL、脂蛋白(a)水平,评估sd-LDL、脂蛋白(a)水平对不稳定斑块的预测价值。结果与无斑块组比较,稳定斑块组和不稳定斑块组美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)显著升高,不稳定斑块组总胆固醇显著升高,高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)显著降低,对照组NIHSS评分、总胆固醇、三酰甘油、LDL-C显著降低,HDL-C显著升高,差异有统计学意义(P<0.05);与稳定斑块组比较,不稳定斑块组NIHSS评分、LDL-C、sdLDL、脂蛋白(a)显著升高,HDL-C显著降低,对照组脂蛋白(a)显著降低,差异有统计学意义(P<0.05)。Pearson相关性分析显示,sd-LDL、脂蛋白(a)水平与NIHSS评分、总胆固醇、三酰甘油、LDL-C呈显著正相关(P<0.05,P<0.01),与HDL-C呈显著负相关(P<0.01)。二元logistic回归分析显示,NIHSS评分、LDL-C、sd-LDL、脂蛋白(a)是ACI患者颈动脉不稳定斑块形成的危险因素,HDL-C是保护因素(P<0.01)。ROC曲线结果显示,sd-LDL、脂蛋白(a)及联合检测对颈动脉斑块稳定性预测的ROC曲线下面积分别为0.830、0.847、0.921,联合检测的敏感性高于sd-LDL、脂蛋白(a)单项指标检测(93.44%vs 88.52%、86.89%,P=0.000)。结论血浆sd-LDL、脂蛋白(a)水平与ACI患者颈动脉斑块稳定性具有一定关联性,可作为临床相关参考指标。Objective To analyze the relationship between small dense low-density lipoprotein(sd-LDL)and lipoprotein(a)and carotid plaque stability in patients with acute cerebral infarction(ACI).Methods A total of 160 elderly ACI patients admitted in our hospital from February 2020 to February 2024 were retrospectively recruited.All of them received cervical color Doppler ultrasound examination,and according to carotid plaque status,they were divided into non-plaque group(43 cases),stable plaque group(56 cases)and unstable plaque group(61 cases).Another 40 healthy individuals taking physical examination in our hospital during the same period served as control group.The clinical data and sd-LDL and Lp(a)levels were compared among the 4 groups to evaluate the predictive value of sd-LDL and Lp(a)levels for unstable plaques.Results When compared with the non-plaque group,the NIHSS score and LDL-C level were significantly increased in the stable and unstable plaque groups,and the TC level was obviously elevated while that of HDL-C was notably reduced in the unstable plaque group,and the NIHSS score and TC,TG and LDL-C levels were remarkably declined while that of HDL-C elevated in the control group(P<0.05).The NIHSS score and LDL-C,sdLDL and Lp(a)levels were elevated while that of HDL-C was lowered in the unstable plaque group than the stable plaque group(P<0.05),and the Lp(a)level in the control group was obviously decreased than that of the stable plaque group(P<0.05).Pearson correlation analysis showed that sd-LDL and Lp(a)levels were positively correlated with NIHSS score and TC,TG and LDL-C(P<0.05,P<0.01),and negatively with HDL-C(P<0.01).Binary logistic regression analysis revealed that NIHSS score and LDL-C,sd-LDL and Lp(a)levels were risk factors,and HDL-C was a protective factor for unstable carotid plaque in ACI patients(P<0.01).ROC curve analysis indicated that the AUC value of sd-LDL,Lp(a)and their combination in predicting carotid plaque stability was 0.830,0.847 and 0.921,respectively,and the sensitivity of combine

关 键 词：脑梗死 颈动脉狭窄 脂蛋白类 LDL 脂蛋白A 

分 类 号：R743.33[医药卫生—神经病学与精神病学]