脂蛋白(a)与易损斑块相关性研究进展
Progress in the Study of the Correlation between Lipoprotein (a) and Vulnerable Plaque
DOI: 10.12677/acm.2025.1592637, PDF,   
作者: 薛 艳:延安大学医学院,陕西 延安;高 燕*:延安大学附属医院高血压心衰科,陕西 延安
关键词: 脂蛋白a易损斑块冠心病Lipoprotein (a) Vulnerable Plaque Coronary Heart Disease
摘要: 循环中脂蛋白(a) [Lp(a)]浓度升高是冠状动脉粥样硬化性心脏病(CHD)发生发展的独立致病风险因素,尤其与冠状动脉易损斑块的形成、进展及破裂风险高度相关。Lp(a)主要通过驱动动脉粥样硬化进程、激发炎症反应以及增强血栓形成倾向等机制发挥作用,构成动脉粥样硬化性心血管疾病(ASCVD)的独立预测指标。流行病学调查、全基因组关联分析(GWAS)及孟德尔随机化(MR)研究均有力证实了Lp(a)升高在CHD发病中的因果关联。本文系统评述了Lp(a)水平与多种易损斑块影像学特征(包括薄纤维帽、大脂质坏死核心、斑块内出血、正性重构、点状微钙化及炎症活动增强)之间关联的最新证据,为未来CHD的精准防治策略奠定重要理论基础。
Abstract: Elevated levels of lipoprotein a (Lp(a)) in the bloodstream serve as an independent risk factor for the development of coronary atherosclerotic heart disease (CHD), particularly associated with the formation, progression, and rupture risks of vulnerable plaques in coronary arteries. Lp(a) exerts its effects primarily through mechanisms that drive atherosclerosis progression, stimulate inflammatory responses, and enhance thrombosis predisposition, establishing it as a key independent predictor of atherosclerotic cardiovascular diseases (ASCVD). Epidemiological surveys, genome-wide association studies (GWAS), and Mendelian randomization (MR) studies have all strongly confirmed the causal link between elevated Lp(a) and CHD onset. This systematic review synthesizes the latest evidence linking Lp(a) levels to various imaging features of vulnerable plaques—including thin fibrous caps, large lipid necrotic cores, intraplaque hemorrhages, positive remodeling, punctate microcalcifications, and enhanced inflammatory activity—thereby laying crucial theoretical foundations for developing precision prevention and treatment strategies for CHD.
文章引用:薛艳, 高燕. 脂蛋白(a)与易损斑块相关性研究进展[J]. 临床医学进展, 2025, 15(9): 1399-1405. https://doi.org/10.12677/acm.2025.1592637

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