Chen Ruomeng, Zhang Kun, Liu Hui, Liu Lijuan, Li Hui, Yan Yan, Zhou Zhou, Meng Chaoyue, Wang Xuelin, Wu Haoran, Miao Ruihan, Wang Rui, Liu Xiaoyun
Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, People's Republic of China.
Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang City, Hebei Province, People's Republic of China.
Diabetes Metab Syndr Obes. 2025 May 17;18:1631-1641. doi: 10.2147/DMSO.S502459. eCollection 2025.
This study aimed to investigate the effect of LP(a) on recurrent ischemic stroke among persons with and without diabetes, providing a basis for the precise management of patients with recurrent ischemic stroke with diabetes in clinical practice.
This study was conducted on consecutive patients with cerebral infarction diagnosed between January 2019 and March 2023 in the Second Hospital of Hebei Medical University. Stratified analyses were performed according to LP(a) level (≤/>90th percentile) and logistic regression modeling was performed to investigate the relationship between LP(a) and recurrent ischemic stroke with or without T2DM.
In the final enrollment of 2029 patients, the number of recurrent ischemic stroke according to LP(a) >90th percentile combined with T2DM was 59.15%, which was significantly higher than in LP(a) ≤90th percentile combined with T2DM (46.17%, =0.039). After multivariate adjustment, LP(a) >90th percentile emerged as an independent risk factor for patients with T2DM (OR=2.062, 95% CI 1.218-3.489, =0.007). In patients with large artery atherosclerotic ischemic stroke, LP(a) was an independent risk factor for recurrent ischemic stroke in diabetic patients (OR=2.553, 95%CI 1.385-4.707, = 0.003), while this was not in non-diabetic patients ( = 0.228).
LP(a) is an independent risk factor for recurrent ischemic stroke in the diabetic population but not in nondiabetic individuals. Simple categorization based on the presence or absence of comorbid T2DM significantly influences the association between LP(a) and recurrent ischemic stroke. Therefore, in clinical practice, for ischemic stroke patients with comorbid diabetes, the LP(a) level should be more strictly controlled.
本研究旨在调查脂蛋白(a)[LP(a)]对有或无糖尿病患者复发性缺血性卒中的影响，为临床实践中对糖尿病复发性缺血性卒中患者的精准管理提供依据。
本研究对2019年1月至2023年3月在河北医科大学第二医院确诊的连续性脑梗死患者进行。根据LP(a)水平(≤/＞第90百分位数)进行分层分析，并进行逻辑回归建模，以研究LP(a)与有或无2型糖尿病(T2DM)的复发性缺血性卒中之间的关系。
在最终纳入的2029例患者中，LP(a)＞第90百分位数合并T2DM的复发性缺血性卒中患者数量占比为59.15%，显著高于LP(a)≤第90百分位数合并T2DM的患者(46.17%，P = 0.039)。多因素调整后，LP(a)＞第90百分位数成为T2DM患者复发性缺血性卒中的独立危险因素(比值比[OR]=2.062，95%置信区间[CI] 1.218 - 3.489，P = 0.007)。在大动脉粥样硬化性缺血性卒中患者中，LP(a)是糖尿病患者复发性缺血性卒中的独立危险因素(OR = 2.553，95%CI 1.385 - 4.707，P = 0.003)，而在非糖尿病患者中并非如此(P = 0.228)。
LP(a)是糖尿病患者复发性缺血性卒中的独立危险因素，但在非糖尿病个体中不是。基于是否合并T2DM的简单分类显著影响LP(a)与复发性缺血性卒中之间的关联。因此，在临床实践中，对于合并糖尿病的缺血性卒中患者，应更严格地控制LP(a)水平。
