Yin Dongliang, Shao Peng, Liu Yunling
aDepartment of Neurology, Jinan 3rd Peoples Hospital bDepartment of Endocrinology, Qianfoshan Hospital of Shandong Province, Jinan cDepartment of Rehabilitation Medicine, Yantaishan Hospital, Yantai, China.
Neuroreport. 2016 Jan 6;27(1):39-44. doi: 10.1097/WNR.0000000000000496.
Lipoprotein (a) [Lp(a)] plays a crucial role in the pathogenesis of deep vein thrombosis (DVT). The purpose of this study was to investigate whether Lp(a) serum levels at admission could be a risk factor for DVT in Chinese patients with acute ischemic stroke (AIS). A total of 232 patients with AIS were included in the study. The patients were assessed for DVT using colour Doppler ultrasonography. We performed colour Doppler ultrasonography 15 days after the stroke and whenever clinically requested. The value of Lp(a) to predict the DVT was analyzed using logistic regression analysis after adjusting for the possible confounders. In our study, 44 out of the 232 patients (19.0%) were diagnosed with DVT at 15-day follow-up. Serum Lp(a) levels were higher in AIS with DVT than in those patients without DVT [656 (interquartile range, 521-898) mg/l vs. 253 (interquartile range, 143-440) mg/l; P<0.0001]. Increased risk of DVT associated with Lp(a) levels greater than or equal to 300 mg/l was found in the multivariate analysis [odds ratio 12.14, 95% confidence interval (CI): 3.08-42.09; P<0.0001]. Visible by the receiver operating characteristic, the optimal cutoff value of serum Lp(a) levels for predicting DVT was projected to be 420 mg/l, yielding a sensitivity of 88.5% and a specificity of 75.4%. With an area under the curve (AUC) of 0.89 (95% CI, 0.84-0.94), Lp(a) exhibited greater discrimination in predicting DVT compared with Hs-CRP (AUC, 0.77; 95% CI, 0.69-0.85; P<0.01), HCY (AUC, 0.76; 95% CI, 0.68-0.84; P<0.01), and NIHSS score (AUC, 0.74; 95% CI, 0.66-0.82; P<0.001). Elevated serum Lp(a) levels were independent predictors of DVT in AIS patients in China, revealing the critical role played by Lp(a) in the pathogenesis of DVT.
脂蛋白(a)[Lp(a)]在深静脉血栓形成(DVT)的发病机制中起关键作用。本研究旨在探讨急性缺血性卒中(AIS)中国患者入院时的Lp(a)血清水平是否可能是DVT的危险因素。共有232例AIS患者纳入本研究。采用彩色多普勒超声对患者进行DVT评估。我们在卒中后15天以及临床需要时进行彩色多普勒超声检查。在对可能的混杂因素进行校正后，采用逻辑回归分析Lp(a)预测DVT的价值。在我们的研究中，232例患者中有44例(19.0%)在15天随访时被诊断为DVT。AIS合并DVT患者的血清Lp(a)水平高于未发生DVT的患者[656(四分位间距，521 - 898)mg/l对253(四分位间距，143 - 440)mg/l；P<0.0001]。多因素分析发现，Lp(a)水平大于或等于300mg/l与DVT风险增加相关[比值比12.14，95%置信区间(CI)：3.08 - 42.09；P<0.0001]。根据受试者工作特征曲线可见，预测DVT的血清Lp(a)水平最佳截断值预计为420mg/l，敏感性为88.5%，特异性为75.4%。Lp(a)曲线下面积(AUC)为0.89(95%CI，0.84 - 0.94)，与超敏C反应蛋白(Hs-CRP)(AUC，0.77；95%CI，0.69 - 0.85；P<0.01)、同型半胱氨酸(HCY)(AUC，0.76；95%CI，0.68 - 0.84；P<0.01)和美国国立卫生研究院卒中量表(NIHSS)评分(AUC，0.74；95%CI，0.66 - 0.82；P<0.001)相比，Lp(a)在预测DVT方面具有更好的辨别力。血清Lp(a)水平升高是中国AIS患者DVT的独立预测因素，揭示了Lp(a)在DVT发病机制中所起的关键作用。
