The Clinical Study On The Association Between Lipoprotein(a) And Large Atherosclerotic Ischemic Stroke

Objective:1.To discuss the distribution and influencing factors of the concentration of lipoprotein(a)among acute large artery atherosclerosis stroke and non-stroke patients,who were admitted in Department of Neurology,Zhongda Hospital.2.To investigate the association between lipoprotein(a)and large atherosclerotic ischemic stroke(LAA stroke).Methods:Retrospectively investigate the acute LAA stroke(CISS type)patients treated in Department of Neurology,Zhongda Hospital during 2013.9-2016.9.The patients without acute cerebrovascular disease admitted to general ward are used as control group in the same period.Blood samples were collected on the next day after admission,then the blood routine examination,the biochemistry complete set,the fibrinolytic assay were determined.The relationship between serum Lp(a)concentration and biochemical,fibrinolysis index and other serum lipids are analyzed by Spearman correlation analysis.The association among those indexes and large artery atherosclerotic stroke risk is analyzed by single factor and multivariate logistic regression analysis.The predictive value of lipoprotein(a)and ApoB/ApoAl for the risk of large atherosclerotic stroke were analyzed by ROC curveResults:1.In LAA group,the ratio of the male,the smokers,the alcohol users and the diabetics,and the age,the blood pressure,the white blood cell,the neutrophils cell ratio,ESR,HsCRP,HbA1c,total bilirubin,direct bilirubin,fasting blood glucose,ApoB/ApoA1,HCY,FIB,FDP,DD are significantly higher than those of control group,the ratio of the famel,the lymphocyte ratio,total protein,albumin,TC,HDL,ApoA1,TT are significantly lower than the control group(P<0.05).Logistic regression analysis shows that WBC(OR:1.786(1.149,2.777)),HbA1C(OR:5.229(1.945,14.061)),Direct bilirubin(OR:4.041(2.130,7.667)),total protein(OR:0.846(0.749,0.955)),Lp(a)(OR:1.004(1.001,7.667)),FIB(OR:3.913(1.254,12.205)),smoke history(OR:4.738(1.160,19.355))enterthe equation.2.Lp(a)serum concentration is highly skewed in the study population,the median is 248(152.25,394.5)mg/L.Spearman correlation analysis finds that Lp(a)serum concentration is independent of age,BMI,but related to prealbumin(r=-0.169,P=0.036),total bilirubin(r=-0.163,P=0.033),INR(r=0.154,P=0.046)?3.ROC curve analysis shows that the area under the ApoB/ApoAI ROC curve is 0.609,P=0.013,cut off value 0.207,the sensitivity 65.1%,specificity 55.6%.The area under the Lp(a)ROC curve is 0.464,P=0.407,cut off value 186.5,the sensitivity 34.9%,specificity 68.9%.Conclusion:1.Increased Lp(a),FIB,WBC,direct bilirubin,glycosylated hemoglobin and decreased total protein might be the independent risk factors for LAA stroke.2.Lp(a)serum concentration is highly skewed in the study population,negatively correlated with prealbumin and total bilirubin,and positively correlated with INR?3.ApoB/ApoA1 of a high level can predict the high risk of large atherosclerotic stroke.