血清脂蛋白(a)及相关血脂指标预测缺血性卒中病人颈动脉斑块风险的临床价值

目的 研究血清脂蛋白(a)Lp (a)]及相关血脂指标预测缺血性卒中颈动脉斑块风险的临床价值.方法 将河北医科大学第一医院109例缺血性卒中病人纳入研究样本,根据颈动脉内中膜厚度(IMT)分为无斑块组(48例)与斑块组(61例),结合斑块及超声特征将斑块组分为稳定斑块组(34例)与不稳定斑块组(27例),比较三组Lp(a)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,分析血脂异常与颈动脉斑块阳性的相关性及血脂异常检测颈动脉斑块的符合率、敏感性及特异性,以一元线性回归分析法分析血脂指标与IMT厚度的相关性,建立Lp(a)对颈动脉斑块的风险预测模型,分析Lp(a)预测颈动脉斑块形成的有效界值.结果 无斑块组、斑块稳定组及斑块不稳定组TG比较差异无统计学意义(P>0.05),无斑块组→斑块稳定组→斑块不稳定组HDL-C呈递减趋势,组间差异有统计学意义(P<0.05),TC、LDL-C、Lp(a)呈递增趋势,组间差异有统计学意义(P<0.05);血脂异常共63例,血脂异常与IMT增厚存在正相关关系(r=0.413,P=0.021),血脂异常诊断颈动脉斑块符合率85.32%(93/109),敏感性88.52%(54/61),特异性81.25%(39/48);一元线性回归分析显示TC、LDL-C、Lp(a)与IMT厚度正相关(R2=0.911、0.741、0.946),HDL-C与IMT厚度负相关(R2=0.356);Lp(a)对颈动脉斑块风险预测模型:ROC曲线下面积0.815,标准误0.047,P=0.000,95%CI=0.723~0.907.最佳截断值为325 mg·L-1,此时敏感性78.3%,特异性93.9%.结论 血脂水平异常可作为颈动脉斑块阳性的辅助预测指标,而Lp(a)可预测颈动脉斑块风险,具有较高的临床价值.

The clinical value of serum lipoprotein (a) and serum lipid index in predicting the risk of carotid plaque in patients with ischemic stroke

Objective To study the clinical value of serum lipoprotein (a) Lp (a)] and related serum lipid parameters in predicting the risk of carotid artery plaque formation in patients with ischemic stroke.Methods 109 patients with ischemic stroke were included in the study.According to carotid intima-media thickness (IMT),they were divided into non-plaque group (48 cases) and plaque group (61 cases).Plaque group was divided into stable plaque group (34 cases) and unstable plaque group (27 cases),combined with the plaque and ultrasonic features.The levels of Lp (a),triglyceride (TG),total cholesterol (TC),high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were compared between the three groups.The relationship between dyslipidemia,positive carotid plaque and the coincidence rate,sensitivity and specificity of dyslipidemia in detecting carotid plaque were analyzed.The correlation between serum lipid parameters and IMT was analyzed by unitary linear regression analysis.The risk prediction model of Lp (a) on carotid artery plaque was established,and the effective cut-off value of Lp (a) in predicting carotid plaque formation was analyzed.Results There were no significant difference in TG between the non-plaque group,stable plaque group and unstable plaque group (P>0.05).HDL-C in non-plaque group,stable plaque group and unstable plaque group showed an decreasing trend (P<0.05) while TC,LDL-C and Lp (a) showed an increasing trend (P<0.05) There was a total of 63 patients with dyslipidemia,and there was a positive correlation between dyslipidemia and IMT thickening (r=0.413,P=0.021).The coincidence rate,sensitivity and specificity of dyslipidemia in diagnosing carotid artery plaque were 85.32% (93/109),88.52%(54/61) and 81.25% (39/48) respectively.Unitary linear regression analysis showed that TC,LDL-C and Lp (a) were positively correlated with IMT (R2=0.911、0.741、0.946) while HDL-C was negatively correlated with IMT (R2=0.356).For Lp (a) in predicting the risk of carotid artery plaque model,the area under ROC was 0.815 and standard error was 0.047,P=0.000,95%CI=0.723-0.907.The optimal cut-off value was 325 mg·L-1,and the sensitivity and specificity were 78.3% and 93.9% respectively.Conclusion Abnormal serum lipid levels can be used as the auxiliary predictors for positive carotid plaque and Lp (a) can predict the risk of carotid plaque,with high clinical value.