血清脂蛋白a、脂蛋白相关磷脂酶A2与代谢综合征合并缺血性脑卒中静脉溶栓患者临床预后的相关性分析

doi:10.20047/j.issn1673-7210.2023.35.20

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摘要目的了解血清脂蛋白a[Lp（a）]、脂蛋白相关磷脂酶A2（Lp-PLA2）与代谢综合征合并缺血性脑卒中静脉溶栓患者临床预后的相关性。方法选取2020年1月至2022年3月山西省临汾市中心医院收治的107例代谢综合征合并缺血性脑卒中超急性期患者为研究对象，所有患者入院完善常规检查后接受阿替普酶静脉溶栓治疗。收集患者的临床资料与Lp（a）、Lp-PLA2水平。根据患者入院时及入院后7 d的美国国立卫生院卒中量表变化将其分为近期改善组（67例）和近期未改善组（40例），另外根据患者入院时及入院后90 d的改良Rankin量表评分变化将其分为远期改善组（72例）和远期未改善组（35例）。分别比较其临床资料及Lp（a）、Lp-PLA2的差异，分析近、远期预后的影响因素，并对影响因素进一步进行预测价值分析。结果近期未改善组总胆固醇、甘油三酯、低密度脂蛋白、Lp（a）、Lp-PLA2水平均高于近期改善组（P＜0.05）。远期未改善组总胆固醇、低密度脂蛋白、Lp（a）、Lp-PLA2水平均高于远期改善组（P＜0.05）。logistic回归模型分析显示，低密度脂蛋白（OR=1.073，95%CI：1.011～1.734）、Lp（a）（OR=1.833，95%CI：1.631～2.341）、Lp-PLA2（OR=1.725，95%CI：1.237～2.113）是代谢综合征合并缺血性脑卒中静脉溶栓患者近期预后的影响因素（P＜0.05）；Lp（a）（OR=1.743，95%CI：1.531～2.293）、Lp-PLA2（OR=1.685，95%CI：1.106～2.131）是代谢综合征合并缺血性脑卒中静脉溶栓患者远期预后的影响因素（P＜0.05）。Lp（a）、Lp-PLA2对代谢综合征合并缺血性脑卒中静脉溶栓患者近、远期预后均有一定的预测价值（P＜0.05）。结论代谢综合征合并缺血性脑卒中静脉溶栓患者血清Lp（a）、Lp-PLA2水平对其近、远期预后有影响，具有一定预后预测价值，值得临床工作中重点关注。

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	陈艳丽　　赵晓东　　梁　辉　　裴金瑞　　周海民　　李万英

关键词 ：脂蛋白a, 脂蛋白相关磷脂酶A2, 代谢综合征, 缺血性脑卒中, 静脉溶栓

Abstract：Objective To investigate the correlation between serum lipoprotein a (Lp[a]), lipoprotein-associated phospholipase A2 (LP-PLA2), and clinical prognosis in patients with metabolic syndrome complicated with ischemic stroke treated with intravenous thrombolytic therapy. Methods A total of 107 patients with metabolic syndrome combined with hyperacute ischemic stroke admitted to Linfen Central Hospital of Shanxi Province from January 2020 to March 2022 were selected as the study objects. All patients received intravenous thrombolytic therapy with Alteplase after completing routine examination. Clinical data and Lp[a] and LP-PLA2 tests were collected. According to the changes of the National Institutes of Health stroke scale at admission and seven days after admission, the patients were divided into a recent improvement group (67 cases) and a recent no improvement group (40 cases), and according to the changes of the modified Rankin scale score at admission and 90 days after admission, the patients were divided into a long-term improvement group (72 cases) and a long-term no improvement group (35 cases). The clinical data and the differences of Lp[a] and LP-PLA2 were compared respectively, and the influencing factors of recent and long-term prognosis were analyzed, and the predictive value of the influencing factors was further analyzed. Results The levels of total cholesterol, triglyceride, low density lipoprotein, Lp[a], and LP-PLA2 in recent no improvement group were higher than those in recent improvement group (P＜0.05). The levels of total cholesterol, low density lipoprotein, Lp[a], and LP-PLA2 in the long-term no improvement group were higher than those in the long-term improvement group (P＜0.05). Logistic regression analysis showed that low-density lipoprotein (OR=1.073, 95%CI: 1.011-1.734), Lp[a] (OR=1.833, 95%CI: 1.631-2.341), LP-PLA2 (OR=1.725, 95%CI: 1.237-2.113) were the influencing factors of recent prognosis in patients with metabolic syndrome complicated with ischemic stroke treated with intravenous thrombolytic therapy (P＜0.05); Lp[a] (OR=1.743, 95%CI: 1.531-2.293), and LP-PLA2 (OR=1.685, 95%CI: 1.106-2.131) were the factors influencing the long-term prognosis of patients with metabolic syndrome complicated with ischemic stroke treated with intravenous thrombolytic therapy (P＜ 0.05). Lp[a] and LP-PLA2 could predict the recent and long-term prognosis of patients with metabolic syndrome complicated with ischemic stroke (P＜0.05). Conclusion Serum Lp[a] and LP-PLA2 levels in patients with metabolic syndrome complicated with intravenous thrombolysis of ischemic stroke have an influence on the near and long term prognosis, and have a certain prognostic value, which is worthy of attention in clinical work.

Key words： Lipoprotein a Lipoprotein-associated phospholipase A2 Metabolic syndrome Ischaemic stroke Intravenous thrombolytic therapy

基金资助:山西省医学重点科研计划项目（2021XM19）。

通讯作者: 李万英（1966-），女，主任医师；研究方向：脑血管病及眩晕的诊治。

作者简介: 陈艳丽（1986-），女，硕士；研究方向：脑血管病。

引用本文:

陈艳丽　　赵晓东　　梁　辉　　裴金瑞　　周海民　　李万英. 血清脂蛋白a、脂蛋白相关磷脂酶A2与代谢综合征合并缺血性脑卒中静脉溶栓患者临床预后的相关性分析[J]. 中国医药导报, 2023, 20(35): 92-97.
CHEN Yanli ZHAO Xiaodong LIANG Hui PEI Jinrui ZHOU Haimin LI Wanying. Correlation analysis of serum lipoprotein a, lipoprotein-associated phospholipase A2, and clinical prognosis in patients with metabolic syndrome complicated with ischemic stroke treated with intravenous thrombolytic therapy. 中国医药导报, 2023, 20(35): 92-97.

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https://www.yiyaodaobao.com.cn/CN/10.20047/j.issn1673-7210.2023.35.20 或 https://www.yiyaodaobao.com.cn/CN/Y2023/V20/I35/92