血清脂蛋白（a）与缺血性脑卒中关系的临床研究

目的探讨脂蛋白（a）（Lp（a））是否为缺血性卒中的危险因素，以及Lp（a）水平与缺血性脑卒中类型和预后的关系。方法将缺血性脑卒中患者按急性卒中治疗低分子肝素试验．TOAST）分型标准分为心源性脑栓塞（CE）、大动脉粥样硬化性卒中（LAA）、小动脉卒中（SAA）、其他原因引发的缺血性卒中（SOE）和原因不明的缺血性卒中（SUE）。以同期入院的非脑卒中患者（经头颅CT或磁共振排除）作为对照组。病例组和对照组均于入院次日清晨空腹抽取静脉血，测定Lp（a）及其他各项血脂指标，并于入院及病程两周时分别行NHISS评分评估神经功能缺损程度，分析Lp（a）与卒中类型及NIHSS评分之间的关系。结果缺血性脑卒中组Lp（a）浓度及异常率均高于对照组（P〈0．05），Lp（a）进入大动脉粥样硬化卒中患病因素的回归方程Lp（a）水平与卒中患者的NIHSS评分无相关性（P〉0．05）。结论高浓度Lp（a）可能参与了缺血性脑卒中的发生，并且可能是大动脉粥样硬化性卒中发生的危险因素，但与神经功能缺失程度和早期功能修复无关。

Clinical study on the relationship between Lp(a) and ischemic stroke

Objective Investigate whether Lp（a） is a risk factor of ischemic stroke and whether Lp （a） impact the prognosis of stroke, and to explore the relationship between Lp（a） and the type of stroke. Methods The ischemic stroke patients were classified into five major ischemic stroke subtypes according to the TOAST criteria： Large-artery atherosclerosis（LAA）, Cardio-embolism（CE）, Small-artery atherosclerosis （SAA）, Stroke of other determined etiology（SOE）, and Stroke of undetermined etiology （SUE）. The patients without acute stroke admitted to general ward were used as control group in the same period. Blood samples were collected on the next day after admission, Lp（a） and other serum lipid were determined by complete automatic plasma biochemistry ,NIHSS scores of on admission and the second week were recorded respectively. Then analysis the relationship between Lp（a） and stroke of kinds and the relationship between Lp（a） and early neuro-function recovery. Results In stroke group, Lp（a） levels were significantly higher than those in the controls （P〈0.05）, there was a significant difference in Lp（a） levels between LAA group and control group （P 〈 0.05）, however there was no relationship between Lp（a） and NIHSS score （P 〉 0.05）. Conclusions High serum Lp（a） level may be a risk factor in ischemic stroke especially in the LAA group, but high-serum Lp（a） was not associated with stroke severity and prognosis.