缺血性脑卒中患者载脂蛋白及血浆脂蛋白相关磷脂酶A2与TOAST病因分型的研究

目的 探讨载脂蛋白（Apo）及血浆脂蛋白相关磷脂酶A2（Lp PLA2）与缺血性脑卒中TOAST病因分型的关系。方法 将388例缺血性脑卒中患者按照经典的TOAST病因分型进行分组，分别为心源性脑栓塞(CE)、大动脉粥样硬化性卒中(LAA)、小动脉卒中/腔隙性脑梗死(SAO)、其他原因引发的缺血性卒中(SOE) 、原因不明的缺血性卒中(SUE)，所有患者次日晨抽取静脉血检测ApoA1、ApoB、ApoH及血浆Lp PLA2。比较各组年龄、高血压、糖尿病、吸烟、饮酒、血脂异常的暴露率; 分析LAA及SAO发病的危险性因素。结果 5组高血压、糖尿病和血脂异常暴露率比较差异有统计学意义(P<0.01)；LAA组及SAO组的Lp PLA2、ApoB水平均高于CE、SOE及SUE组(P<0.05)；LAA组及SAO组的ApoA1水平低于CE、SOE及SUE组(P<0.05)；Lp PLA2、ApoB水平是LAA及SAO患者的危险因素，ApoA1是保护性因素。结论 Lp PLA2及ApoB水平升高是LAA及SAO患者的危险因素，而ApoA1水平升高是保护性因素，血浆Lp PLA2、ApoB及ApoA1水平检测有助于明确缺血性脑卒中的TOAST病因分型。

Correlation study of apolipoprotein and plasma lipoprotein associated phospholipase A2 with TOAST etiology subtypes in patients with ischemic stroke

Objective To explore the relationship between apolipoprotein, lipoprotein associated phospholipase A2(Lp PLA2) and TOAST ischemic stroke etiology subtypes. Methods A total of 388 ischemic stroke patients were enrolled as study subjects, and were classifyied into five groups according to the classical theory TOAST ischemic stroke etiology subtypes：cardiogenic cerebral embolism (CE), large artery atherosclerosis stroke (LAA), small artery stroke/lacunar infarction (SAO), the other causes of ischemic stroke (SOE), unexplained ischemic stroke (SUE). Venous blood tests were comducted on all patients on the next morning of the admission day to determine the levels of apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), apolipoprotein H (Apo H) and plasma phospholipase A2 (Lp PLA2) level. Results There was a significant difference in the exposure rate of hypertension, diabetes and blood lipid abnormal in the 5 groups(P<0.01); the Lp PLA2 and ApoB levels in the LAA group and SAO group were significantly higher than those of CE, SOE and SUE groups(P<0.05); the ApoA1 level in the LAA group and SAO group was significantly lower than those of CE, SOE and SUE groups(P<0.05); whether the patient's stroke etiology subtypes is the LAA, SAO was defined as the dependent variable, age, hypertension, diabetes, alcohol consumption, smoking, dyslipidemia and Lp PLA2, ApoA1, ApoB and ApoH level were defined as independent variables, multivariate binary logistic analysis showed that Lp PLA2 and ApoB were the risk factors of LAA and SAO, while Apo a1 was a protective factor. Conclusion Lp PLA2 and ApoB are the incidence risk factors of LAA and SAO, while ApoA1 whose level undergoing an increase is a protective factor. The level determinations of serum Lp PLA2, ApoB and ApoA1 levels are helpful to pinpoint tne TOAST etiological subtypes of ischemic stroke.