Relationship between serum lipoprotein (a), apolipoprotein B/apolipoprotein A1 ratio and prognosis of acute cerebral infarction treated with alteplase intravenous thrombolysis

doi:10.3877/cma.j.issn.1673-9248.2026.02.010

Abstract

Abstract:

Objective

To analyze the relationship between serum lipoprotein (a) [LP (a)], apolipoprotein B/apolipoprotein A1 ratio (ApoB/ApoA1), and the prognosis of acute cerebral infarction (ACI) treated with intravenous thrombolysis with alteplase (rt-PA).

Methods

A retrospective study was conducted to collect detailed clinical data of 122 patients with ACI who received rt-PA intravenous thrombolysis treatment in the Neurology Department of Beijing Shunyi Hospital from August 2023 to January 2024. Follow-up data of patients after thrombolysis was also queried. The prognosis was evaluated according to the modified Rankin scale (mRS) score at 1 month after thrombolysis. They were divided into poor prognosis group (51 cases, mRS score>2 points) and good prognosis group (71 cases, mRS score≤2 points). The clinical data, cystatin C (Cys C), serum LP (a) level and ApoB/ApoA1 value on the next day after thrombolysis were compared between the two groups. The restricted cubic spline model (RCS) was used to analyze the relationship between serum LP (a) level, ApoB/ApoA1 level and prognosis, and the nomogram and decision curve were drawn to evaluate the predictive value of the two for poor prognosis.

Results

The clinical data comparison on the day after thrombolysis showed that the ApoA1 level in the poor prognosis group was lower than that in the good prognosis group [(0.90 ± 0.28) g/L vs (1.18 ± 0.26) g/L, t=5.731, P<0.001], while the levels of Cys C serum LP (a), and ApoB/ApoA1 were higher than those in the good prognosis group [(1.18±0.42) mg/L vs (0.81±0.34) mg/L, t=5.459, P<0.001; (409.12±56.30) mg/L vs (365.35±48.12) mg/L, t=4.496, P<0.001; 1.26±0.41 vs 0.90±0.28, t=5.419, P<0.001], and the differences were statistically significant. RCS analysis showed a non-linear dose-response relationship between serum LP (a) levels, ApoB/ApoA1, and the prognosis of rt-PA intravenous thrombolysis in ACI patients (all P<0.05). When serum LP (a) >368.25 mg/L, ApoB/ApoA 1>0.91, respectively, the risk of poor prognosis of rt-PA in ACI patients increased with the index level. There was a positive interaction between serum LP (a) and ApoB/ApoA1 on the prognosis of ACI patients treated with rt-PA intravenous thrombolysis the day after thrombolysis. When both were abnormally elevated, the risk of poor prognosis was 28.000 times higher than when both were low. The results of nomogram showed that the risk model discrimination of predicting the prognosis of ACI patients with rt-PA intravenous thrombolysis using serum LP (a) and ApoB/ApoA1 as auxiliary indicators on the day after thrombolysis was good, with a C-index of 0.918 (95% CI: 0.866 - 0.971). The decision curve showed that the net benefit rate of serum LP (a), ApoB/ApoA1 combined with Cys C, and ApoA1 on the day after thrombolysis was higher compared to the application of each indicator alone (the maximum net benefit rate of the combination was 0.418).

Conclusion

Serum LP (a) and ApoB/ApoA1 are associated with the prognosis of ACI patients undergoing rt-PA intravenous thrombolysis. Abnormally high expression of serum LP (a) and ApoB/ApoA1 the day after thrombolysis suggests a higher risk of poor clinical prognosis.

Key words: Intravenous thrombolysis, Acute cerebral infarction, Alteplase, Clinical prognosis

Li'na Li, Ying Peng, Li Gong, Zhidong Zheng. Relationship between serum lipoprotein (a), apolipoprotein B/apolipoprotein A1 ratio and prognosis of acute cerebral infarction treated with alteplase intravenous thrombolysis[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2026, 20(02): 178-184.

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URL: https://zhnxgbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9248.2026.02.010

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Figures/Tables 5

资料	预后不良组（n=51）	预后良好组（n=71）	统计值	P值
性别[例（%）]			χ²=0.804	0.370
男	26（50.98）	42（59.15）
女	25（49.02）	29（40.85）
年龄（岁， $x ¯$ ±s）	64.52±4.15	63.82±3.66	t=0.985	0.327
发病至入院后明确诊断时间（h， $x ¯$ ±s）	2.39±0.51	2.20±0.48	t=0.110	0.912
合并基础疾病[例（%）]
高血压	44（86.27）	56（78.87）	χ²=1.100	0.294
糖尿病	34（66.67）	43（60.56）	χ²=0.475	0.491
吸烟史	27（52.94）	35（49.30）	χ²=0.158	0.691
饮酒史	40（78.43）	59（83.10）	χ²=0.423	0.516
NIHSS评分（分， $x ¯$ ±s）	9.14±2.51	9.04±2.87	t=0.190	0.850
血压（mmHg， $x ¯$ ±s）
舒张压	99.31±4.42	98.60±5.30	t=0.781	0.436
收缩压	146.28±6.41	147.82±6.65	t=1.281	0.203
TG（mmol/L， $x ¯$ ±s）	2.29±0.69	2.25±0.71	t=0.311	0.757
LDL-C（mmol/L， $x ¯$ ±s）	3.98±0.64	3.82±0.70	t=1.290	0.200
TC（mmol/L， $x ¯$ ±s）	6.21±1.08	6.28±1.12	t=0.346	0.730
Cys C（mg/L， $x ¯$ ±s）	1.18±0.42	0.81±0.34	t=5.459	<0.001
SCr（μmol/L， $x ¯$ ±s）	74.86±5.01	75.21±4.69	t=0.395	0.694
LP（a）（mg/L， $x ¯$ ±s）	409.12±56.30	365.35±48.12	t=4.496	<0.001
ApoB（g/L， $x ¯$ ±s）	1.08±0.37	1.03±0.31	t=0.783	0.435
ApoA1（g/L， $x ¯$ ±s）	0.90±0.28	1.18±0.26	t=5.731	<0.001
ApoB/ApoA1（ $x ¯$ ±s）	1.26±0.41	0.90±0.28	t=5.419	<0.001

资料	预后不良组（n=51）	预后良好组（n=71）	统计值	P值
性别[例（%）]			χ²=0.804	0.370
男	26（50.98）	42（59.15）
女	25（49.02）	29（40.85）
年龄（岁， $x ¯$ ±s）	64.52±4.15	63.82±3.66	t=0.985	0.327
发病至入院后明确诊断时间（h， $x ¯$ ±s）	2.39±0.51	2.20±0.48	t=0.110	0.912
合并基础疾病[例（%）]
高血压	44（86.27）	56（78.87）	χ²=1.100	0.294
糖尿病	34（66.67）	43（60.56）	χ²=0.475	0.491
吸烟史	27（52.94）	35（49.30）	χ²=0.158	0.691
饮酒史	40（78.43）	59（83.10）	χ²=0.423	0.516
NIHSS评分（分， $x ¯$ ±s）	9.14±2.51	9.04±2.87	t=0.190	0.850
血压（mmHg， $x ¯$ ±s）
舒张压	99.31±4.42	98.60±5.30	t=0.781	0.436
收缩压	146.28±6.41	147.82±6.65	t=1.281	0.203
TG（mmol/L， $x ¯$ ±s）	2.29±0.69	2.25±0.71	t=0.311	0.757
LDL-C（mmol/L， $x ¯$ ±s）	3.98±0.64	3.82±0.70	t=1.290	0.200
TC（mmol/L， $x ¯$ ±s）	6.21±1.08	6.28±1.12	t=0.346	0.730
Cys C（mg/L， $x ¯$ ±s）	1.18±0.42	0.81±0.34	t=5.459	<0.001
SCr（μmol/L， $x ¯$ ±s）	74.86±5.01	75.21±4.69	t=0.395	0.694
LP（a）（mg/L， $x ¯$ ±s）	409.12±56.30	365.35±48.12	t=4.496	<0.001
ApoB（g/L， $x ¯$ ±s）	1.08±0.37	1.03±0.31	t=0.783	0.435
ApoA1（g/L， $x ¯$ ±s）	0.90±0.28	1.18±0.26	t=5.731	<0.001
ApoB/ApoA1（ $x ¯$ ±s）	1.26±0.41	0.90±0.28	t=5.419	<0.001

变量	变量		OR值	95%CI		RERI	AP	SI
变量	预后不良	预后良好	OR值	下限	上限	RERI	AP	SI
LP（a）/（ApoB/ApoA1）	51	71				21.611	77.18%	5.010
-/-	4	28	1.000	-	-
+/-	8	18	3.111	1.111	14.318
-/+	11	18	4.228	1.157	15.726
+/+	28	7	28.000	9.137	155.556

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