摘要
目的:探讨脂蛋白（a）与同时排除高血压病、高脂血症、糖尿病（简称无“三高”）老年人群小动脉硬化型脑小血管病（aCSVD）的相关性。方法:回顾性纳入徐州医科大学附属徐州市立医院神经内科2016年1月至2021年7月收治住院的aCSVD患者2000例（aCSVD组），按年龄、性别，以1∶2比例配对，选择同期体检中心排除aCSVD的体检者为对照组（非aCSVD组，4000例），根据是否有“三高”史，分出无“三高”亚组（aCSVD组=198，non-aCSVD=396）。对比分析病例组和对照组的相关临床资料，并采用多变量Logistic回归模型分析老年人群及无“三高”老年人群aCSVD的危险因素。结果:在匹配年龄、性别后，老年人群aCSVD组较对照组具有较高比例的高血压病史（56.50% vs 55.16%，χ2=1.548，P=0.006）、糖尿病史（42.50% vs 30.00%，χ2=6.796，P=0.009）及高脂血症史（33.50% vs 31.50%，χ2=7.614，P=0.006），差异均有统计学意义；脂蛋白（a）水平高于对照组，但差异无统计学意义[（0.32±0.11）g/L vs（0.31±0.12）g/L，t=1.876，P=0.061]。多变量Logistic回归分析显示高血压史、糖尿病史可能是老年人群aCSVD的独立危险因素，脂蛋白（a）不是其危险因素。在进行亚组分析时，无“三高”老年人群aCSVD组脂蛋白（a）水平较对照组显著升高，差异有统计学意义[（0.56±0.17）g/L vs （0.49±0.14）g/L，t=5.339，P＜0.001]。进一步多变量Logistic回归分析，结果显示脂蛋白（a）是无“三高”老年人群aCSVD的独立危险因素（OR=1.672，95%CI：1.144~2.317，P=0.007）。结论:脂蛋白（a）是无“三高”老年人群aCSVD的独立危险因素，可作为预测其发病风险的血清生物学标志物。
Abstract
Objective:To investigate the correlation between lipoprotein (a) and arteriosclerotic cerebral small vessel disease (aCSVD) in the elderly population without hypertension,hyperlipidemia, or diabetes (abbreviated "no three high").Methods:2000 patients with aCSVD admitted to Department of Neurology of Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from January 2016 to July 2021 were retrospectively included. Select 4000 cases of the medical check-up who were excluded from aCSVD at the physical examination center during the same period as the control group. The patients were matched by age,sex with a 1∶2 ratio (aCSVD=2000, non aCSVD=4000), and were divided into "no three high" subgroup (aCSVD=198, non aCSVD=396) according to whether they were "no three high" elderly population. The relevant clinical data of the case group and the control group was collected for comparative analysis, and multivariate Logistic regression model was used to analyze the risk factors of aCSVD in the general elderly population and the elderly population without diabetes, hyperlipidemia, and hypertension.Results:This study showed that after matching the age and gender, the elderly aCSVD group had a higher proportion of hypertension (56.50% vs 55.16%, χ2=1.548, P=0.006), diabetes (42.50% vs 30.00%, χ2=6.796, P=0.009), and hyperlipidemia (33.50% vs 31.50%, χ2=7.614, P=0.006) than the control group, and the differences were statistically significant. The level of lipoprotein (a) in aCSVD group was higher than that in the control group, but there was no statistical difference [(0.32±0.11) g/L vs (0.31±0.12) g/L, t=1.876, P=0.061]. Logistic regression analysis showed that the history of hypertension and diabetes may be an independent risk factor for aCSVD in the elderly, but lipoprotein (a) was not an independent risk factor for aCSVD. In the subgroup analysis, the level of lipoprotein (a) in the "no three high" elderly population with aCSVD was significantly higher than that in the control group, with a statistically significant difference [(0.56±0.17) g/L vs (0.49±0.14) g/L, t=5.339, P＜0.001]. Logistic regression analysis showed that lipoprotein (a) was an independent risk factor for aCSVD in the "no three high" elderly population (OR=1.672, 95%CI: 1.144-2.317, P=0.007).Conclusion:Lipoprotein (a) is an independent risk factor of aCSVD in the elderly population without diabetes, hyperlipidemia and hypertension, and it can be used as a serum biomarker to predict the risk of aCSVD.
基金项目
2021年徐州市基础研究计划面上项目(KC21063)
中国矿业大学青年基金项目(2020QN83)
徐州医科大学附属医院科技发展基金项目(XYFY2020034)
万方数据