Department of Hematology and Oncology, Cook Children's Medical Center, 1500 Cooper St, Fort Worth, TX, 76104, USA.
Department of Research Data Science and Analytics, Cook Children's Medical Center, 801 Seventh Avenue, Fort Worth, TX, 76104, USA.
Curr Atheroscler Rep. 2023 Jun;25(6):299-307. doi: 10.1007/s11883-023-01102-5. Epub 2023 May 9.
The goal of this paper is to describe the current understanding of lipoprotein (a) (Lp(a)), clinical practice guidelines, and the potential pathophysiological mechanisms that appear to increase the risk of cardiovascular and thromboembolic events, specifically within the pediatric population.
The proatherogenic and pro-thrombotic properties of Lp(a) may increase the risk of atherothrombotic disease. In adults, atherosclerotic plaques increase thrombotic risk, but antifibrinolytic and proinflammatory properties appear to have an important role in children. Although it is not well established in neonates, recent studies indicate the risk of incident thrombosis and ischemic stroke are approximately fourfold higher in children with elevated Lp(a) which also increases their risk of recurrent events. Despite this higher risk, Pediatric Lp(a) screening guidelines continue to vary among different medical societies and countries. The inconsistency is likely related to inconclusive evidence outside of observational studies and the lack of specific therapies for children with elevated levels. Additional research is needed to improve understanding of the pro-thrombotic mechanisms of Lp(a), appropriate screening guidelines for Lp(a) in the pediatric population, and to elucidate the short and long term effects of elevated Lp(a) on the risk of pediatric thrombosis and stroke.
本文旨在描述脂蛋白 (a)（Lp(a)）的现有认识、临床实践指南，以及似乎增加心血管和血栓栓塞事件风险的潜在病理生理机制，特别是在儿科人群中。
Lp(a) 的促动脉粥样硬化和促血栓形成特性可能会增加动脉粥样硬化性疾病的风险。在成年人中，动脉粥样硬化斑块会增加血栓形成的风险，但抗纤维蛋白溶解和促炎特性似乎在儿童中具有重要作用。尽管在新生儿中尚未得到很好的证实，但最近的研究表明，Lp(a）升高的儿童发生血栓事件和缺血性中风的风险大约高四倍，并且他们的复发风险也更高。尽管存在这种更高的风险，但儿科 Lp(a) 筛查指南在不同的医学协会和国家之间仍存在差异。这种不一致可能与观察性研究之外的证据不明确以及缺乏针对高 Lp(a）水平儿童的特定治疗方法有关。需要进一步研究以提高对 Lp(a) 的促血栓形成机制、儿科人群中 Lp(a) 的适当筛查指南以及阐明升高的 Lp(a) 对儿科血栓形成和中风风险的短期和长期影响的理解。
