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[既往缺血性卒中患者后代的代谢性动脉粥样硬化危险因素评估]

[Assessment of metabolic atherosclerosis risk factors in progeny of patients with past ischemic stroke].

作者信息

Mierzecki Artur, Bukowska Hanna, Honczarenko Krystyna, Jastrzebska Maria, Millo Barbara, Torbus-Lisiecka Barbara

机构信息

Pracownia Kształcenia Lekarzy Rodzinnych Pomorskiej AM w Szczecinie.

出版信息

Pol Arch Med Wewn. 2005 Feb;113(2):119-29.

Abstract

Early diagnosing and modification or elimination of atherosclerosis risk factors with the descendants of the ill with past ischemic stroke (IS) might reduce risk of subsequent stroke incidence in the family, or myocardial infarction or other disease being atherosclerosis - derivative. This subject seems to be essential because it concerns young people. The purpose of the present study is identification and assessment of metabolic atherosclerosis risk factors with adult progeny of the ill with past IS at young age. There were examined 43 adult children of the parents who fell ill at young age (between 39 and 55 years in case of men and 60 years in case of women) with IS. The test group included 21 men and 22 women aged from 19 to 39 years (average age - 26.3 years). The reference group consisted of 40 persons, including 18 men and 22 women aged from 22 to 39 years (average age - 26.8 years). The persons from reference group were corresponding (in respect of structural aspects, such as age and sex) to the test group, their parents had negative history towards atherosclerosis - derivative illnesses. None of the patients under examination was a cigarette smoker. Examination of both groups consisted in conducting anamnesis, measurement of body weighing and height, blood pressure as well as evaluation of biochemical atherosclerosis risk factors. Blood testing (blood serum or plasma) consisted of blood cell count and ESR as well as blood glucose level, creatinine, urea, transaminase and bilirubin levels as well as total cholesterol, LDL cholesterol and HDL cholesterol fractions, apolipoprotein B, apolipoprotein AI, lipoprotein (a), triglycerides, homocysteine, folate, fibrinogen, von Willebrand factor and C-reactive protein level. Among persons whose parents were affected, at young age, with IS higher average level of BMI (24.2 +/- 3.8 kg/m2) was detected as compared with that in the reference group (22.4 +/- 2.5 kg/m2), LDL cholesterol fraction (2.7 +/- 0.8 mmol/l vs 2.4 +/- 0.6 mmol/l) and triglycerides (1.1 +/- 0.4 mmol/l vs 0.8 +/- 0.4 mmol/l) as well as lower level of apolipoprotein Al (1.5 +/- 0.2 g/l vs 1.6 +/- 0.2 g/l). Average values of other factors in the blood serum were not significantly different in both with compared groups. In case of women, whose parents were affected with IS, higher levels of the following indicators were detected: BMI (24.3 +/- 3.9 kg/mz vs 21.5 +/- 2.3 kg/m2), total cholesterol (5.1 +/- 0.7 mmol/l vs 4.4 +/- 0.5 mmol/l, LDL cholesterol (2.7 +/- 0.6 mmol/l vs 2.1 +/- 0.4 mmol/l), apolipoprotein B (1.0 +/- 0.1 g/l vs 0.8 +/- 0.1 g/l), lipoprotein (a) (0.3 +/- 0.2 g/l vs 0.2 +/- 0.1 g/l) and triglycerides (1.0 +/- 0.4 mmol/l vs 0.7 +/- 0.2 mmol/l). In group of men whose parents were affected with IS lower levels of apolipoprotein Al (1.3 +/- 0.2 g/l vs 1.5 +/- 0.2 g/l) and of von Willebrand factor (71.4 +/- 23.9% vs 87.1% +/- 16,8%) were detected. Descendents of the ill with past IS should be treated as higher risk group especially when supranormative values of metabolic atherosclerosis risk factors are detected with them. In case of persons with positive family history of IS, having higher values of metabolic atherosclerosis risk factors, it is necessary to apply intensive actions towards change of their life styles, and if necessary - also to include pharmacological treatment.

摘要

对既往有缺血性卒中(IS)患者的后代进行早期诊断,并改变或消除动脉粥样硬化风险因素,可能会降低家族中后续卒中的发病风险,或降低心肌梗死或其他动脉粥样硬化衍生疾病的风险。这个问题似乎至关重要,因为它涉及年轻人。本研究的目的是识别和评估年轻时曾患IS的成年患者后代的代谢性动脉粥样硬化风险因素。研究对象为43名父母在年轻时(男性39至55岁,女性60岁)患IS的成年子女。试验组包括21名男性和22名女性,年龄在19至39岁之间(平均年龄26.3岁)。对照组由40人组成,包括18名男性和22名女性,年龄在22至39岁之间(平均年龄26.8岁)。对照组人员在结构方面(如年龄和性别)与试验组相对应,其父母无动脉粥样硬化衍生疾病史。所有受试患者均不吸烟。两组的检查包括问诊、测量体重和身高、血压以及评估生化动脉粥样硬化风险因素。血液检测(血清或血浆)包括血细胞计数、血沉以及血糖水平、肌酐、尿素、转氨酶和胆红素水平,以及总胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇组分、载脂蛋白B、载脂蛋白AI、脂蛋白(a)、甘油三酯、同型半胱氨酸、叶酸、纤维蛋白原、血管性血友病因子和C反应蛋白水平。在父母年轻时患IS的人群中,检测到的BMI平均水平(24.2±3.8kg/m²)高于对照组(22.4±2.5kg/m²),低密度脂蛋白胆固醇组分(2.7±0.8mmol/l对2.4±0.6mmol/l)和甘油三酯(1.1±0.4mmol/l对0.8±0.4mmol/l),以及载脂蛋白AI水平较低(1.5±0.2g/l对1.6±0.2g/l)。两组血清中其他因素的平均值无显著差异。在父母患IS的女性中,检测到以下指标水平较高:BMI(24.3±3.9kg/m²对21.5±2.3kg/m²)、总胆固醇(5.1±0.7mmol/l对4.4±0.5mmol/l)、低密度脂蛋白胆固醇(2.7±0.6mmol/l对2.1±0.4mmol/l)、载脂蛋白B(1.0±0.1g/l对0.8±0.1g/l)、脂蛋白(a)(0.3±0.2g/l对0.2±0.1g/l)和甘油三酯(1.0±0.4mmol/l对0.7±0.2mmol/l)。在父母患IS的男性组中,检测到载脂蛋白AI水平较低(1.3±0.2g/l对1.5±0.2g/l)和血管性血友病因子水平较低(71.4±23.9%对87.1%±16.8%)。既往有IS患者的后代应被视为高危人群,尤其是当检测到他们的代谢性动脉粥样硬化风险因素值超过正常范围时。对于有IS家族史且代谢性动脉粥样硬化风险因素值较高的人,有必要采取强化措施改变他们的生活方式,如有必要,还应包括药物治疗。

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