Department of Biochemistry, Dr. D. Y. Patil Medical College, Mumbai, India.
J Stroke Cerebrovasc Dis. 2013 Oct;22(7):e159-67. doi: 10.1016/j.jstrokecerebrovasdis.2012.10.013. Epub 2012 Dec 14.
Inflammation plays a crucial role in the pathogenesis and prognosis of stroke. We studied the behavior of lipoprotein(a) [Lp(a)], ferritin, and albumin as acute phase reactants and their roles in the severity and mortality of stroke.
We recruited 100 consecutive patients with acute ischemic stroke and 120 controls. Blood samples were drawn on days 1 and 7 and at both 3 and 6 months. Stroke was classified using Trial of Org 10172 in Acute Stroke Treatment classification. Stroke severity was assessed using the National Institutes of Health Stroke Scale. Prognosis at 6 months was assessed using the modified Rankin Scale, and mortality was assessed using the Kaplan-Meier analysis. Serum levels of interleukin-6 (IL-6), Lp(a), ferritin, and albumin were measured using enzyme-linked immunosorbent assay, immunoturbidimetry, and chemiluminescence commercial kits, respectively.
Levels of IL-6, Lp(a), and ferritin were consistently higher among cases than controls (P < .0001). Serum Lp(a) levels peaked at day 7 after stroke and tapered thereafter. Albumin levels were lower than controls on admission day and increased subsequently. In our study, Lp(a) acted as an acute phase reactant while albumin acted as a negative acute phase reactant. There was no association between Trial of Org 10172 in Acute Stroke Treatment subtype and elevated serum levels of Lp(a), albumin, and ferritin. Lp(a) and ferritin were high in patients with severe stroke. Albumin was negatively correlated with stroke severity. Serum levels of Lp(a) ≥ 77 mg/dL, albumin ≤ 3.5 g/dL, and ferritin ≥ 370 ng/dL is associated with a significantly increased risk of having a poorer outcome in stroke. Serum levels of Lp(a) >77 mg/dL and albumin <3.5 g/dL were also associated with increased mortality.
High levels of Lp(a) and ferritin and low levels of albumin are associated with increased severity and poorer long term prognosis of stroke. Patients with admission levels of Lp(a) >77 mg/dL and albumin <3.5 g/dL had increased mortality.
炎症在中风的发病机制和预后中起着关键作用。我们研究了脂蛋白（a）[Lp（a）]、铁蛋白和白蛋白作为急性反应蛋白的行为及其在中风严重程度和死亡率中的作用。
我们招募了 100 例连续的急性缺血性中风患者和 120 例对照。在第 1 天和第 7 天以及第 3 个月和第 6 个月抽取血液样本。使用 Org 10172 在急性中风治疗分类中的试验对中风进行分类。使用国立卫生研究院中风量表评估中风严重程度。使用改良 Rankin 量表评估 6 个月时的预后，使用 Kaplan-Meier 分析评估死亡率。使用酶联免疫吸附试验、免疫比浊法和化学发光试剂盒分别测量血清白细胞介素-6（IL-6）、Lp（a）、铁蛋白和白蛋白的水平。
与对照组相比，病例组的 IL-6、Lp（a）和铁蛋白水平始终较高（P <.0001）。中风后第 7 天血清 Lp（a）水平达到峰值，随后逐渐下降。入院当天白蛋白水平低于对照组，随后逐渐升高。在我们的研究中，Lp（a）作为急性反应蛋白，而白蛋白作为负急性反应蛋白。Org 10172 在急性中风治疗亚型与血清 Lp（a）、白蛋白和铁蛋白水平升高之间没有关联。严重中风患者的 Lp（a）和铁蛋白较高。白蛋白与中风严重程度呈负相关。血清 Lp（a）≥77mg/dL、白蛋白≤3.5g/dL 和铁蛋白≥370ng/dL 与中风不良结局的风险显著增加相关。血清 Lp（a）>77mg/dL 和白蛋白<3.5g/dL 也与死亡率增加相关。
高水平的 Lp（a）和铁蛋白以及低水平的白蛋白与中风严重程度和预后不良相关。入院时 Lp（a）>77mg/dL 和白蛋白<3.5g/dL 的患者死亡率增加。
