王洪 宋淑华

【摘要】 目的：探討脂蛋白（a）[Lp（a）]和颈动脉粥样硬化及脑梗死之间的关系，以便为临床诊治提供参考依据。方法：选取2015年1月-2017年12月本院收治的脑梗死患者60例为观察组，另选取同期健康体检者60例为对照组。两组均检测Lp（a）、低密度脂蛋白（LDL）、促甲状腺激素（TCHO）、高密度脂蛋白（HDL）、载脂蛋白A1（apoA1）水平，采取彩色多普勒超声测定两组颈动脉粥样硬化情况。观察两组颈动脉粥样硬化检出率，比较两组Lp（a）、LDL、TCHO、HDL、apoA1水平，比较颈动脉粥样硬化有无斑块者Lp（a）水平。结果：观察组颈动脉粥样硬化检出率为70.00%，高于对照组的30.00%，比较差异有统计学意义（字2=19.200 0，P=0.000 0）；两组LDL、TCHO、HDL、apoA1水平比较差异均无统计学意义（P>0.05），但观察组Lp（a）明显高于对照组（P<0.05）；有斑块者Lp（a）水平高于无斑块者（P<0.05）。结论：脑梗死患者较健康人群存在明显的颈动脉粥样硬化情况，而且Lp（a）水平更高，同时颈动脉粥样硬化斑块者Lp（a）水平高于无斑块者，可见Lp（a）与颈动脉粥样硬化及脑梗死之间存在相关关系，临床应加强重视。

【关键词】 脑梗死； 颈动脉粥样硬化； 脂蛋白（a）； 血脂

【Abstract】 Objective：To investigate the correlation between lipoprotein（a）[Lp（a）]and carotid atherosclerosis and cerebral infarction，in order to provide reference for clinical diagnosis and treatment.Method：A total of 60 patients with cerebral infarction admitted to our hospital from January 2015 to December 2017 were selected as the observation group，and another 60 healthy persons in the same period were selected as control group.The levels of Lp（a），low density lipoprotein （LDL），thyroid stimulating hormone（TCHO），high density lipoprotein（HDL），apolipoprotein A1（apoA1） were detected in two groups，and carotid atherosclerosis in two groups was measured by color Doppler ultrasound.The detection rates of carotid atherosclerosis in two groups were observed，the levels of Lp（a），LDL，TCHO，HDL and apoA1 between two groups were compared，and the Lp（a） level of carotid atherosclerotic plaques and without plaques was compared.Result：The detection rate of carotid atherosclerosis in observation group was 70.00%，which was higher than 30.00% in control group，the difference was statistically significant（字2=19.200 0，P=0.000 0）.The levels of LDL，TCHO，HDL and apoA1 in two groups were compared，the differences were not statistically significant（P>0.05），but the Lp（a） level in observation group was significantly higher than that of control group （P<0.05）.The Lp（a） level of carotid atherosclerotic plaques was higher than that of without plaques（P<0.05）.Conclusion：Cerebral infarction patients showed obvious carotid atherosclerosis compared with healthy subjects，the Lp（a） level is higher，at the same time，the Lp（a） level of carotid atherosclerotic plaques was higher than that of those without plaques，can be seen that Lp（a） is correlated with carotid atherosclerosis and cerebral infarction，which should be paid more attention in clinic.

【Key words】 Cerebral infarction； Carotid atherosclerosis； Lipoprotein（a）； Blood lipid

First-authors address：Tongzhou District Hospital of Traditional Chinese Medicine，Nantong 226300，China

doi：10.3969/j.issn.1674-4985.2018.31.030

脑血管病发生率在近几年有所升高，对人类的身体健康造成不同程度影响，而且致残率与死亡率较高，影响生存质量，需加强重视。脑血管疾病中缺血性脑血管病占了75%左右[1-4]，在一些研究与报道中显示，大部分缺血性脑血管病患者存在颈动脉粥样硬化斑块不稳定脱落现象，进而导致脑栓塞，即动脉粥样硬化栓塞，可见不稳定斑块在缺血性脑血管病中有着重要作用[5-7]。脑梗死属于高发性疾病，起病急骤，进展快速，死亡率高[8]。脑梗死患者可能存在颈动脉粥样硬化现象，而近期相关研究报道中指出脂蛋白（a）[Lp（a）]有促进动脉粥样硬化与血栓形成等作用[9-11]，为了探讨Lp（a）与颈动脉粥样硬化及脑梗死的关系，本院将2015年1月-2017年12月收治的脑梗死患者60例与健康体检者60例实施了比较研究。现……