摘要
脂蛋白(a)[Lp(a)]是一种低密度脂蛋白类似颗粒,其血清浓度在个体中较为稳定,主要受LPA基因调控,具有明显种族差异。目前已证实高Lp(a)血清水平是心血管疾病的致病因素,其可能通过参与动脉粥样硬化过程、影响纤溶系统功能发挥作用。多项研究提示,Lp(a)与缺血性卒中存在相关性,尤其在青年卒中人群中,但目前结论仍不统一。传统降脂方案他汀类药物或贝特类药物无法有效降低血清Lp(a)水平。目前可能治疗方案包括前蛋白转化酶枯草杆菌蛋白酶Kexin-9抑制剂、胆固醇酯转移蛋白,抗载脂蛋白(a)或载脂蛋白B的靶向反义寡核苷酸治疗及血浆分离技术等,其临床获益有待进一步研究证实。作者就Lp(a)的结构性质、与缺血性卒中的相关性、其可能的致病机制和降Lp(a)治疗最新进展方面予以综述。
Lipoprotein(a)(Lp[a]) is an low density lipoprotein-like particle with constant individual concentration through life determined mainly by LPA gene variations and racial difference.Previous studies had proved the causal relationship between Lp(a) and cardiovascular disease due to potential pathogenic mechanisms including proatherogenic and prothrombotic effect.Lp(a) had been reported to be associated with ischemic stroke by many studies,especially among young people,but the conclusions remain controversial.Traditional lipid-lowering therapies,such as statins or fibrates do not effectively reduce Lp(a) levels.Possible treatment options consist of proprotein convertase subtilisin/kexin type 9 inhibitors,cholesteryl ester transfer protein,antisense oligonucleotide and apheresis,but their clinical benefits need to be confirmed by further trials.In this review,aspects of Lp(a) including the structure properties,correlation with ischemic stroke,probable pathophysiological mechanisms and recent advances in lowering Lp(a) are summarized.
作者
付瀚辉
彭斌
Fu Hanhui;Peng Bin(Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2019年第6期327-331,共5页
Chinese Journal of Cerebrovascular Diseases
基金
国家重点研发计划精准医学研究专项(2016YFC0901004)
北京协和医学院2016年度校级研究生教育教学改革项目(10023201600104)
