脂蛋白(a)、同型半胱氨酸与早期缺血性脑卒中家族史。

Torbus-Lisiecka B, Bukowska H, Jastrzebska M, Chelstowski K, Honczarenko K, Naruszewicz M

Regional Center for Atherosclerosis Research, Pomeranian Academy of Medicine, 70-111 Szczecin, Al. Powstańców Wlkp. 72, Poland.

Nutr Metab Cardiovasc Dis. 2001 Oct;11 Suppl 5:52-9.

BACKGROUND AND AIM

High plasma lipoprotein(a) [Lp(a)] and homocysteine (HCY) levels are now considered to be independent risk factors for cerebro- and cardiovascular atherosclerotic occlusive disease, but little is known about the influence of Lp(a) and HCY on the early events of ischemic disease or their significance in subjects with a positive family history of ischemia. The aim of this study was to evaluate the relationship between HCY levels and the severity of ischemic cerebral stroke, and investigate whether there was a correlation between Lp(a) and HCY levels in the stroke patients and their children.

METHODS

The study involved 35 patients with early ischemic cerebral stroke aged 46.1 +/- 6.6 years and their 50 children aged 17.2 +/- 5.5 years. The patients were grouped on the basis of the form of the stroke (transient, progressive or complete stroke), and their levels of Lp(a), HCY, uric acid (UA), fibrinogen (Fb) and factor VII (FVII) activity were measured.

RESULTS

HCY and Lp(a) concentrations increased with the severity of the ischemia, being highest in the patients with complete stroke (15.1 +/- 2.9 mumol/L and 32.9 +/- 37.6 mg/dL respectively). A similar trend was found in the offspring, with the highest HCY and Lp(a) values in the children of complete stroke patients (12.6 +/- 4.4 mumol/L and 23.0 +/- 24.6 mg/dL). The control values were respectively 8.7 +/- 1.6 mumol/L and 5.35 +/- 7.05 mg/dL. The following correlations between the parents and children were noted: Lp(a) (r = 0.87 p < 0.0001), UA (r = 0.71 p < 0.001), HCY (r = 0.45 p < 0.05), FVII (r = 0.45 p < 0.05), and Fb (r = 0.42 p = 0.06). Correlations between Lp(a) and HCY (r = 0.47 p < 0.05) and Fb and FVII (r = 0.60 p < 0.01) were found in the children. Multiple regression analysis revealed that only Lp(a) and Fb significantly influenced HCY levels in the offspring with a positive family history.

CONCLUSIONS

HCY levels correlate with the severity of ischemic cerebral stroke and, in families with a history of ischemic cerebral stroke, the levels of the risk factors in children are determined by the levels in their parents.

背景与目的

血浆脂蛋白(a)[Lp(a)]和同型半胱氨酸(HCY)水平升高目前被认为是脑血管和心血管动脉粥样硬化闭塞性疾病的独立危险因素，但关于Lp(a)和HCY对缺血性疾病早期事件的影响或其在有缺血性家族史的受试者中的意义，人们了解甚少。本研究的目的是评估HCY水平与缺血性脑卒严重程度之间的关系，并调查脑卒中患者及其子女的Lp(a)与HCY水平之间是否存在相关性。

方法

本研究纳入了35例年龄为46.1±6.6岁的早期缺血性脑卒中患者及其50名年龄为17.2±5.5岁的子女。根据脑卒中类型（短暂性、进展性或完全性脑卒中）对患者进行分组，并测量他们的Lp(a)、HCY、尿酸(UA)、纤维蛋白原(Fb)和因子VII(FVII)活性水平。

结果

HCY和Lp(a)浓度随着缺血严重程度的增加而升高，在完全性脑卒中患者中最高（分别为15.1±2.9μmol/L和32.9±37.6mg/dL）。在后代中也发现了类似的趋势，完全性脑卒中患者的子女中HCY和Lp(a)值最高（分别为12.6±4.4μmol/L和23.0±24.6mg/dL）。对照值分别为8.7±1.6μmol/L和5.35±7.05mg/dL。父母与子女之间存在以下相关性：Lp(a)(r = 0.87，p < 0.0001)、UA(r = 0.71，p < 0.001)、HCY(r = 0.45，p < 0.05)、FVII(r = 0.45，p < 0.05)和Fb(r = 0.42，p = 0.06)。在子女中发现Lp(a)与HCY(r = 0.47，p < 0.05)以及Fb与FVII(r = 0.60，p < 0.01)之间存在相关性。多元回归分析显示，在有家族史的后代中，只有Lp(a)和Fb对HCY水平有显著影响。