Watts G F, Mazurkiewicz J C, Tonge K, Nelson V, Warburton F G, Slavin B M
University Department of Medicine, University of Western Australia, Royal Perth Hospital.
QJM. 1995 May;88(5):321-6.
We measured fasting serum lipids, lipoproteins, apolipoproteins and lipoprotein(a) [Lp(a)] in 49 Caucasian patients with transient ischaemic attacks undergoing carotid angiography. The severity of extracranial cerebrovascular disease was assessed visually by a highly reproducible grading system that focused on the internal carotid artery and carotid bifurcation. Compared with a healthy reference group, patients had significantly higher serum concentrations of: total cholesterol (mean +/- SD), 6.2 +/- 1.6 vs. 5.6 +/- 1.0 mmol/l, p = 0.02; apolipoprotein B, 1.4 +/- 0.5 vs. 1.2 +/- 0.3 g/l, p = 0.03; triglyceride [geometric mean(95% CI)], 2.02(1.75-2.32) vs. 1.66(0.67-4.06) mmol/l, p = 0.03; and Lp(a), 0.33(0.26-0.42) vs. 0.17(0.40-0.76) g/l, p < 0.001. Regression analysis showed that of the lipoprotein-related variables, only Lp(a) was significantly related to the severity of carotid artery disease (p = 0.04) in the patients; this association remained significant after adjusting for age, sex, blood pressure, and a history of stroke. Serum Lp(a) concentration was significantly higher in patients with carotid artery disease severity score above the median value of the sample population compared with those below the median: 0.45 vs. 0.24 g/l (95% CI for difference 0.35-0.88), p = 0.01. Elevated serum Lp(a) is a significant determinant of the extent of carotid atherosclerosis and may be useful in identifying patients most at risk of stroke.
我们对49例接受颈动脉血管造影的短暂性脑缺血发作的白种人患者进行了空腹血清脂质、脂蛋白、载脂蛋白和脂蛋白(a)[Lp(a)]的检测。通过一个高度可重复的分级系统对颅外脑血管疾病的严重程度进行了可视化评估，该系统聚焦于颈内动脉和颈动脉分叉处。与健康对照组相比，患者的血清浓度显著更高的有：总胆固醇（均值±标准差），6.2±1.6 vs. 5.6±1.0 mmol/L，p = 0.02；载脂蛋白B，1.4±0.5 vs. 1.2±0.3 g/L，p = 0.03；甘油三酯[几何均值(95%可信区间)]，2.02(1.75 - 2.32) vs. 1.66(0.67 - 4.06) mmol/L，p = 0.03；以及Lp(a)，0.33(0.26 - 0.42) vs. 0.17(0.40 - 0.76) g/L，p < 0.001。回归分析显示，在患者中，脂蛋白相关变量中只有Lp(a)与颈动脉疾病的严重程度显著相关（p = 0.04）；在调整年龄、性别、血压和中风病史后，这种关联仍然显著。与样本人群中位数以下的患者相比，颈动脉疾病严重程度评分高于中位数的患者血清Lp(a)浓度显著更高：0.45 vs. 0.24 g/L（差异的95%可信区间为0.35 - 0.88），p = 0.01。血清Lp(a)升高是颈动脉粥样硬化程度的一个重要决定因素，可能有助于识别中风风险最高的患者。
