Tyurina Alexandra V, Afanasieva Olga I, Ezhov Marat V, Klesareva Elena A, Balakhonova Tatiana V, Pokrovsky Sergei N
A.L. Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology n.a. acad. E.I. Chazov, Ministry of Health of the Russian Federation, Moscow 121552, Russia.
Institute of Experimental Cardiology, National Medical Research Center of Cardiology n.a. acad. E.I. Chazov, Ministry of Health of the Russian Federation, Moscow 121552, Russia.
Diseases. 2025 Jun 26;13(7):196. doi: 10.3390/diseases13070196.
Elevated lipoprotein(a) [Lp(a)] levels are a key factor in the early formation and progression of atherosclerosis. Monocytes in individuals with an elevated Lp(a) level are represented by an activated inflammatory phenotype and have an increased ability for transendothelial migration. This work studies the association between Lp(a), monocytes, and the progression of carotid atherosclerosis in patients with premature coronary heart disease (CHD).
This study included 102 patients with CHD manifested before 55 in men and 60 in women who underwent two carotid duplex scans with an interval of 5 [3; 8] years. The criteria for the progression of carotid atherosclerosis were the appearance of new plaque and an increase in stenosis by >10% in any of the six segments. The lipid profile, Lp(a), and hematology with the calculation of the lymphocyte-monocyte ratio (LMR) were determined in all the patients.
The median blood monocyte count was 0.54 × 10/L, and the median LMR was 4.18. In 70 patients, we revealed the criteria for carotid atherosclerosis progression. The groups did not differ by demographics, risk factors, or the blood lipid and lipoprotein levels, except for Lp(a); this concentration was higher in the patients with carotid atherosclerosis progression. The odds of atherosclerosis progression were highest in the patients with an elevated Lp(a) level and a blood monocyte count above the median (16.8, 3.4-83.0, < 0.001). Carotid atherosclerosis progression was associated with LMR < 4.18 and an elevated Lp(a) level (OR = 4.3, 1.1-17.2, = 0.04) and not associated with the patients with Lp(a) levels < 30 mg/dL and an LMR above the median.
An elevated Lp(a) level and monocyte count provide the highest probability of the progression of carotid atherosclerosis in patients with premature CHD.
脂蛋白(a)[Lp(a)]水平升高是动脉粥样硬化早期形成和进展的关键因素。Lp(a)水平升高个体中的单核细胞表现为活化的炎症表型，其跨内皮迁移能力增强。本研究探讨Lp(a)、单核细胞与早发冠心病（CHD）患者颈动脉粥样硬化进展之间的关系。
本研究纳入102例男性55岁前、女性60岁前发病的CHD患者，这些患者接受了两次颈动脉双功超声扫描，间隔时间为5[3；8]年。颈动脉粥样硬化进展的标准为出现新斑块，且六个节段中任何一个节段的狭窄增加>10%。测定所有患者的血脂谱、Lp(a)以及计算淋巴细胞-单核细胞比率（LMR）的血液学指标。
血液单核细胞计数中位数为0.54×10/L，LMR中位数为4.18。在70例患者中，我们发现了颈动脉粥样硬化进展的标准。除Lp(a)外，两组在人口统计学、危险因素、血脂和脂蛋白水平方面无差异；颈动脉粥样硬化进展患者的该浓度更高。Lp(a)水平升高且血液单核细胞计数高于中位数的患者发生动脉粥样硬化进展的几率最高（16.8，3.4 - 83.0，<0.001）。颈动脉粥样硬化进展与LMR<4.18和Lp(a)水平升高相关（OR = 4.3，1.1 - 17.2，= 0.04），而与Lp(a)水平<30 mg/dL且LMR高于中位数的患者无关。
Lp(a)水平升高和单核细胞计数增加使早发CHD患者颈动脉粥样硬化进展的可能性最高。
