血清脂蛋白(a)与穿支动脉粥样硬化病患者早期神经功能恶化的相关性  

Correlation between serum lipoprotein(a)and early neurological deterioration in patients with branch atherosclerotic disease

作　　者：陆佳洁 严佳男 龚鹏宇 Lu Jiajie;Yan Jia'nan;Gong Pengyu(Department of Neurology,Affiliated Hospital of Nantong University,Nantong 226000,China)

机构地区：[1]南通大学附属医院神经内科,南通226000

出　　处：《国际脑血管病杂志》2024年第11期821-826,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的:探讨脂蛋白(a)与穿支动脉粥样硬化病(branch atheromatous disease,BAD)患者早期神经功能恶化(early neurological deterioration,END)的相关性。方法:回顾性纳入2024年1月至2024年9月在南通大学附属医院住院的BAD患者。收集人口统计学和基线临床资料。END定义为发病1周内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线增加≥2分,其中运动功能评分增加≥1分。应用多变量logistic回归分析确定BAD患者END的独立危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线评价脂蛋白(a)对END的预测价值。结果:共纳入214例BAD患者,男性134例(62.6%),年龄(65.60±11.96)岁,中位基线NIHSS评分3分(四分位数间距:2~5分),中位发病至入院时间16 h(四分位数间距:10~24 h),中位发病至采血时间25 h(四分位数间距:20~38 h)。141例(65.89%)为豆纹动脉供血区梗死,73例(34.11%)为脑桥旁正中动脉供血区梗死。28例(13.08%)接受静脉溶栓治疗,72例(33.64%)发生END。单变量分析显示,END组性别构成、基线NIHSS评分、血清Lp(a)以及接受静脉溶栓的患者比例与非END组差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,脂蛋白(a)较高[优势比(odds ratio,OR)1.033,95%置信区间(confidence interval,CI)1.015~1.052;P<0.001]和静脉溶栓(OR 2.799,95%CI 1.109~7.065;P=0.029)是BAD患者发生END的独立危险因素。ROC曲线分析显示,脂蛋白(a)预测END的曲线下面积为0.621(95%CI 0.54~0.70)。最佳截断值23.36 mg/dl,敏感性和特异性分别为45.8%和76.8%。结论:脂蛋白(a)较高与BAD患者END相关,但对END的预测价值有限。Objective:To investigate the correlation between lipoprotein(a)and early neurological deterioration(END)in patients with branch atherosclerotic disease(BAD).Methods:Patients with BAD admitted to the Affiliated Hospital of Nantong University from January 2024 to September 2024 were included retrospectively.The demographic and baseline clinical data were collected.END was defined as an increase of≥2 in the National Institutes of Health Stroke Scale(NIHSS)score from baseline within 1 week after onset,including an increase of≥1 in motor function score.Multivariate logistic regression analysis was used to identify the independent risk factors for END in patients with BAD.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of lipoprotein(a)for END.Results:A total of 214 patients with BAD were enrolled;including 134 males(62.6%),aged 65.60±11.96 years.The median baseline NIHSS score was 3(interquartile range,2-5),the median onset-to-door time was 16 hours(interquartile range,10-24 hours),and the median onset to blood collection time was 25 hours(interquartile range,20-38 hours).141 patients(65.89%)had lenticulostriate arteries infarction,and 73 patients(34.11%)had paramedian pontine arteries infarction.28 patients(13.08%)received intravenous thrombolysis,and 72(33.64%)experienced END.Univariate analysis showed that there were significant differences in gender composition,baseline NIHSS score,serum lipoprotein(a),and proportion of patients receiving intravenous thrombolysis between the END group and the non-END group(all P<0.05).Multivariate logistic regression analysis showed that higher lipoprotein(a)(odds ratio[OR]1.033,95%confidence interval[CI]1.015-1.052;P<0.001)and intravenous thrombolysis(OR 2.799,95%CI 1.109-7.065;P=0.029)were the independent risk factors for END in patients with BAD.ROC curve analysis showed that the area under the curve of lipoprotein(a)for predicting END was 0.621(95%CI 0.54-0.70).The optimal cutoff value was 23.36 mg/dl.The sensitivity and specificity w

关 键 词：颅内动脉硬化 缺血性卒中 疾病恶化 脂蛋白(a) 危险因素 试验预期值 

分 类 号：R743[医药卫生—神经病学与精神病学]