糖尿病病程与Lp-PLA2活性对急性缺血性卒中临床结局的影响分析

doi:10.3969/j.issn.1673-5765.2026.06.007

摘要/Abstract

摘要： 目的探讨糖尿病病程与脂蛋白相关磷脂酶A2（lipoprotein-associated phospholipase A2，Lp-PLA2）活性对急性缺血性卒中或TIA患者临床结局的影响。
方法选取中国国家卒中登记Ⅲ（the third China national stroke registry，CNSR-Ⅲ）研究中连续入组的急性缺血性卒中或TIA患者为研究对象。收集患者的人口学资料、既往病史、临床特征、实验室指标、影像资料等基线数据。通过面对面访谈明确患者的基线糖尿病病程，将其分为无糖尿病组、糖尿病病程<8年组和糖尿病病程≥8年组，并采集其基线血液样本以检测Lp-PLA2活性。采用Cox比例风险回归模型和多变量logistic回归模型，分析糖尿病病程与Lp-PLA2活性对患者1年随访期内卒中复发、全因死亡及不良功能结局（mRS评分3～6分）的影响，并明确二者是否存在交互作用。采用Kaplan-Meier法绘制临床结局的生存曲线，组间差异采用log-rank检验进行比较。
结果本研究共纳入CNSR-Ⅲ研究中的10 398例急性缺血性卒中或TIA患者。在1年随访期中，共1021例（9.82%）患者卒中复发，348例（3.35%）患者发生全因死亡，1369例（13.17%）患者出现不良功能结局。相较于Lp-PLA2活性≤21.6 nmol·mL-1·min-1的患者，校正潜在混杂因素后，糖尿病病程≥8年组中Lp-PLA2活性≥194.8 nmol·mL－1·min－1的患者1年卒中复发风险升高（HR 1.85，95%CI 1.17～2.91，P=0.008）；糖尿病病程＜8年组（HR 3.22，95%CI 1.45～7.18，P=0.004）和糖尿病病程≥8年组（HR 2.61，95%CI 1.16～5.89，P=0.021）中Lp-PLA2活性≥194.8 nmol·mL-1·min-1的患者1年全因死亡风险升高。交互作用分析显示，Lp-PLA2活性与糖尿病病程对卒中复发、全因死亡及不良功能结局的影响均无交互作用（P交互值分别为0.545、0.132、0.769）。
结论对于急性缺血性卒中/TIA患者，尽管未发现糖尿病病程与Lp-PLA2活性之间存在显著的交互作用，但长期（≥8年）糖尿病合并高Lp-PLA2活性可独立增加卒中复发与全因死亡风险。

文章导读： 本研究基于中国国家卒中登记Ⅲ队列证实，长期（≥8年）糖尿病合并高脂蛋白相关磷脂酶A2活性可使卒中复发风险增加85%，且二者均为独立危险因素，提示临床中需对此类高危人群采取“控糖+抗炎”双重强化管理。

关键词: 急性缺血性卒中; 糖尿病病程; 脂蛋白相关磷脂酶A2; 临床结局

Abstract: Objective To investigate the influences of diabetes duration and lipoprotein-associated phospholipase A2 (Lp-PLA2) activity on the clinical outcomes in patients with acute ischemic stroke or TIA.
Methods Patients with acute ischemic stroke or TIA who were consecutively enrolled in the third China national stroke registry (CNSR-Ⅲ) were selected as study subjects. Baseline data including demographic data, medical history, clinical characteristics, laboratory indicators, and imaging data were collected. Diabetes duration at baseline was determined through face-to-face interviews. Patients were divided into three groups: no diabetes, diabetes duration<8 years, and diabetes duration≥8 years, and their baseline blood samples were collected to detect Lp-PLA2 activity. Cox proportional hazards regression and multivariate logistic regression models were used to analyze the effects of diabetes duration and Lp-PLA2 activity on stroke recurrence, all-cause mortality, and poor functional outcome (mRS score of 3-6 points) during the 1-year follow-up period, and to determine whether there was an interaction between the two factors. The survival curves of clinical outcomes were plotted using the Kaplan-Meier method, and the differences between groups were compared using the log-rank test.
Results A total of 10 398 patients with acute ischemic stroke or TIA from the CNSR-Ⅲ study were included in this study. During the 1-year follow-up period, 1021 (9.82%) patients had recurrent stroke, 348 (3.35%) died from any cause, and 1369 (13.17%) had poor functional outcome. After adjusting for potential confounders, compared with patients with Lp-PLA2 activity≤21.6 nmol·mL-1·min-1, patients with diabetes duration≥8 years and Lp-PLA2 activity≥194.8 nmol·mL-1·min-1 showed a higher risk of 1-year stroke recurrence (HR 1.85, 95%CI 1.17-2.91, P=0.008); patients with Lp-PLA2 activity≥194.8 nmol·mL-1·min-1 showed a higher risk of 1-year all-cause mortality, no matter whether the diabetes duration＜8 years (HR 3.22, 95%CI 1.45-7.18, P=0.004) or≥8 years (HR 2.61, 95%CI 1.16-5.89, P=0.021). Interaction analysis showed no significant interaction between Lp-PLA2 activity and diabetes duration on stroke recurrence, all-cause mortality, or poor functional outcome (P values for interaction were 0.545, 0.132, and 0.769, respectively).
Conclusions In patients with acute ischemic stroke/TIA, although no significant interaction was observed between diabetes duration and Lp-PLA2 activity, long-standing (≥8 years) diabetes combined with high Lp-PLA2 activity independently increased the risks of stroke recurrence and all-cause mortality.

Key words: Acute ischemic stroke; Diabetes duration; Lipoprotein-associated phospholipase A2; Clinical outcome

中图分类号:

林金嬉, 李上智, 张艳丽, 高培元, 周宏宇. 糖尿病病程与Lp-PLA2活性对急性缺血性卒中临床结局的影响分析[J]. 中国卒中杂志, 2026, 21(6): 703-711.

LIN Jinxi, LI Shangzhi, ZHANG Yanli, GAO Peiyuan, ZHOU Hongyu. Impact of Diabetes Duration and Lp-PLA2 Activity on Acute Ischemic Stroke Clinical Outcomes[J]. Chinese Journal of Stroke, 2026, 21(6): 703-711.

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链接本文: https://www.chinastroke.org.cn/CN/10.3969/j.issn.1673-5765.2026.06.007

https://www.chinastroke.org.cn/CN/Y2026/V21/I6/703

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