缺血性脑卒中患者颈动脉斑块性质与非高密度脂蛋白胆固醇浓度的相关性

doi:10.3969/j.issn.1006-7795.2023.01.008

摘要/Abstract

摘要： 目的探讨缺血性脑卒中老年患者不同类型的颈动脉斑块性质与血清非高密度脂蛋白胆固醇(non-high density lipoprotein-cholesterol,non-HDL-C)表达水平的关系。方法选取在开封市中心医院神经内科住院的400例动脉粥样硬化性脑梗死患者,依据颈部血管超声结果分为:稳定斑块组与不稳定斑块组。同期在本院体检中心的400例健康者设为对照组。所有入选者空腹抽取肘静脉血,使用全自动生化分析仪检测血脂和non-HDL-C。结果 2组患者血清non-HDL-C浓度差异有统计学意义(P<0.05);脑梗死患者不稳定斑块组non-HDL-C浓度较稳定斑块组增高,non-HDL-C分别为(3.81±0.99)mmol/L、(2.92±0.72) mmol/L,2组比较,差异均有统计学意义(P<0.05)。经Spearman相关分析,缺血性脑卒中老年患者颈动脉斑块的不稳定性与血清non-HDL-C表达水平呈正相关(r=0.521,P<0.01)。Logistic回归分析结果表明,non-HDL-C是颈动脉不稳定斑块的重要危险因素(OR=3.990,95%CI:2.369~6.720)。结论缺血性脑卒中老年患者non-HDL-C升高发生颈动脉不稳定斑块的危险性明显增大,是颈动脉不稳定斑块的重要危险因素。

关键词: 非高密度脂蛋白胆固醇, 斑块, 颈动脉, 动脉硬化, 缺血性脑卒中

Abstract: Objective To investigate the relationship between non-high density lipoprotein-cholesterol (non-HDL-C) and artery plaque characterization of stroke. Methods The hospitalized patients diagnosed as atherosclerotic stroke in the neurological department of Kaifeng Central Hospital were recruited as the experimental group (400 cases), who were divided as the stable and unstable plaque groups, according to the stenosis intensity. Another 400 healthy controls were recruited. The serum levels of non-HDL-C of all the patients and control groups were detected. Results The levels of non-HDL-C were significantly different (P<0.05) between the stroke group and the health control. The levels of non-HDL-C in the unstable plaque group were significantly higher than that in the stable control group, and the mean of non-HDL-C was (3.81±0.99)mmol/L and (2.92±0.72)mmol/L,respectively, with significant difference (P<0.05). Spearman correlation ananlysis showed the levels of non-HDL-C was positively correlated with the unstable plaque (r=0.521, P<0.01). Logistic regression analysis showed that non-HDL-C was an important risk factor for carotid artery unstable plaque(OR=3.990,95%CI:2.369－6.720). Conclusion There was correlation between the non-HDL-C and arterial plaque characteristic in ischemic stroke patients, which can be used as the important basis for clinical examination.

Key words: non-high density lipoprotein-cholesterol, plaque, carotid artery, atherosclerosis, ischemic stroke

中图分类号:

R543

徐建可, 刘宁, 韩苗, 张洪阳, 韩新生. 缺血性脑卒中患者颈动脉斑块性质与非高密度脂蛋白胆固醇浓度的相关性[J]. 首都医科大学学报, 2023, 44(1): 49-53.

Xu Jianke, Liu Ning, Han Miao, Zhang Hongyang, Han Xinsheng. Analysis of the relationship between non-high-density lipoprotein cholesterol and arterial plaque characteristic in a cohort of ischemic stroke patients[J]. Journal of Capital Medical University, 2023, 44(1): 49-53.

参考文献

[1] Wang W Z, Jiang B, Sun H X, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults[J]. Circulation, 2017, 135(8): 759－771.
[2] Serra R, Barbetta A, Fugetto F, et al. Emergent treatment of carotid stenosis: an evidence-based systematic review[J]. Minerva Chir, 2018, 73(5): 505－511.
[3] Hou Q T, Yu C, Li S Y, et al. Characteristics of lipid profiles and lipid control in patients with diabetes in a tertiary hospital in Southwest China: an observational study based on electronic medical records[J]. Lipids Health Dis, 2019, 18(1): 13.
[4] 陈伟伟, 高润霖, 刘力生, 等. 《中国心血管病报告2016》概要[J]. 中国循环杂志, 2017, 32(6): 521－530.
[5] 中华医学会. 各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[6] Gilbert O, Croffoot J R, Taylor A J, et al. Serum lipid concentrations among persons with spinal cord injury - a systematic review and meta-analysis of the literature[J]. Atherosclerosis, 2014, 232(2): 305－312.
[7] Aznaouridis K, Masoura C, Vlachopoulos C, et al. Statins in stroke[J]. Curr Med Chem, 2019, 26(33): 6174－6185.
[8] 李运航. Non-HDLC与ApoB作为动脉粥样硬化性心血管疾病预防目标的研究进展[J]. 海南医学, 2021, 32(8): 1043－1047.
[9] Yi L, Tang J, Shi C G, et al. Pentraxin 3, TNF-α, and LDL-C are associated with carotid artery stenosis in patients with ischemic stroke[J]. Front Neurol, 2020, 10:1365.
[10] Cherepanov D, Bentley T G K, Hsiao W, et al. Real-world cardiovascular disease burden in patients with atherosclerotic cardiovascular disease: a comprehensive systematic literature review[J]. Curr Med Res Opin, 2018, 34(3): 459－473.
[11] Raina R, Young C, Krishnappa V, et al. Role of lipoprotein apheresis in cardiovascular disease risk reduction[J]. Blood Purif, 2019, 47(4): 301－316.
[12] Nesti L, Mengozzi A, Natali A, et al. Statins, LDL cholesterol control, cardiovascular disease prevention, and atherosclerosis progression: a clinical perspective[J]. Am J Cardiovasc Drugs, 2020, 20(5): 405－412.
[13] Pahlavanzade B, Zayeri F, Baghfalaki T, et al. Association of lipid markers with coronary heart disease and stroke mortality: a 15-year follow-up study[J]. Iran J Basic Med Sci, 2019, 22(11): 1325－1330.
[14] Yeh Y T, Yin W H, Tseng W K, et al. Lipid lowering therapy in patients with atherosclerotic cardiovascular diseases: which matters in the real world? Statin intensity or low-density lipoprotein cholesterol level?－Data from a multicenter registry cohort study in Taiwan[J]. PLoS One, 2017, 12(10): e0186861.
[15] 梁有峰, 郭增, 程宝山, 等. 非高密度脂蛋白胆固醇与载脂蛋白A-I比值与冠状动脉慢血流相关性分析[J]. 中国心血管病研究, 2022, 20(2): 161－165.
[16] Wu B, Yu Z W, Tong T, et al. Evaluation of small dense low-density lipoprotein concentration for predicting the risk of acute coronary syndrome in Chinese population[J]. J Clin Lab Anal, 2020, 34(3): e23085.
[17] 李友凤, 王春慧, 孙文先, 等. 总胆固醇/高密度脂蛋白胆固醇比值对脑卒中复发的预测价值[J]. 中国实用神经疾病杂志, 2020, 23(9): 771－775.
[18] Wu J W, Wang A X, Li X, et al. Non-high-density lipoprotein cholesterol levels on the risk of asymptomatic intracranial arterial stenosis: a result from the APAC study[J]. Sci Rep, 2016, 6: 37410.
[19] Wu J W, Chen S Y, Liu L P, et al. Non-high-density lipoprotein cholesterol vs low-density lipoprotein cholesterol as a risk factor for ischemic stroke: a result from the Kailuan study[J]. Neurol Res, 2013, 35(5): 505－511.
[20] 王玮婧, 金蔚涛, 任红卫, 等. 非高密度脂蛋白与颈动脉粥样硬化程度的相关性研究[J]. 中华老年心脑血管病杂志, 2017, 19(9): 945－947.
[21] Emerging Risk Factors Collaboration. Major lipids, apolipoproteins, and risk of vascular disease[J]. JAMA, 2009, 302(18): 1993－2000.
[22] Imamura T, Doi Y, Ninomiya T, et al. Non-high-density lipoprotein cholesterol and the development of coronary heart disease and stroke subtypes in a general Japanese population: the Hisayama Study[J]. Atherosclerosis, 2014, 233(2): 343－348.
[23] Tanabe N, Iso H, Okada K, et al. Serum total and non-high-density lipoprotein cholesterol and the risk prediction of cardiovascular events - the JALS-ECC -[J]. Circ J, 2010, 74(7): 1346－1356.
[24] 郑刚. 秋水仙碱在心血管病防治中的地位和临床意义[J]. 中华老年心脑血管病杂志, 2022, 24(2): 216－218.
[25] 韩新生, 徐建可,李相磊,等.急性脑梗死患者Cathepsin S/Cystatin C水平与动脉斑块性质及狭窄程度的相关性分析[J].中风与神经疾病杂志,2018,35(5):434-438.
[26] 韩新生, 裘丽红,杨成森,等.前循环缺血性卒中患者颈动脉颅内外段血管粥样硬化斑块特点分析[J].实用医学杂志,2014,(17):2776-2778.