脂蛋白(a)与颈动脉粥样硬化不稳定斑块的关系OA北大核心CSTPCD

Objective To investigate the relationship between lipoprotein(a)[Lp(a)]and unstable carotid atherosclerotic plaque. Methods Patients with ischemic cerebrovascular disease(including ischemic stroke,TIA and chronic cerebral ischemia)who were hospitalized in the Department of Neurology,Beijing Chaoyang Hospital,Capital Medical University from January to December 2022 were retrospectively included.All patients completed Lp(a)test and carotid ultrasound examination.According to the plaque echo characteristics of carotid ultrasound,the patients were divided into unstable plaque group and stable plaque group.The upper limit of normal Lp(a)level(30 mg/dL)was selected as the critical value.Multivariate logistic regression was used to analyze the effect of elevated Lp(a)level on unstable carotid atherosclerotic plaque.In addition,the effect of Lp(a)on unstable carotid atherosclerotic plaque at different levels of LDL-C was analyzed with LDL-C level of 1.8 mmol/L as the critical value. Results A total of 747 eligible patients were enrolled in this study,including 484 males(64.8%),with a median age of 66(58-72)years.Univariate analysis showed that patients in the unstable plaque group was older,with higher proportions of male,history of hypertension,diabetes mellitus and stroke,and higher levels of Lp(a),Hcy and glycosylated hemoglobin.Multivariate logistic regression analysis showed that elevated Lp(a)was an independent risk factor of unstable carotid atherosclerotic plaque(OR1.65,95%CI1.02-2.68,P=0.04).Subgroup analysis showed that Lp(a)had no significant effect on unstable carotid atherosclerotic plaque when LDL-C<1.8 mmol/L(OR1.41,95%CI0.34-5.93),but there was no interaction between the LDL-C and Lp(a)levels on unstable carotid atherosclerotic plaque. Conclusions Elevated Lp(a)was associated with unstable carotid atherosclerotic plaque.However,at low LDL-C levels,the effect of elevated Lp(a)on unstable carotid atherosclerotic plaque was not significant.