Non-HDL-C和Hcy联合应用在急性缺血性脑卒中的应用价值  

Application value of Non-HDL-C combined with Hcy in acute ischemic stroke*

作　　者：朱亚 付毓平 燕莎 贺志安 郭凤霞 ZHU Ya;FU Yuping;YAN Sha;HE Zhi'an;GUO Fengxia(Department of Clinical Laboratory,Henan Provincial People's Hospital/Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;School of Medicine Laboratory,Sanquan College of Xinxiang Medical University,Xinxiang,Henan 453003,China;Department of Inspection Center,Henan Provincial Hospital of Traditional Chinese Medicine/the Second Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan 450002,China)

机构地区：[1]河南省人民医院/郑州大学人民医院检验科,河南郑州450003 [2]新乡医学院三全学院医学检验学院,河南新乡453003 [3]河南省中医院/河南中医药大学第二附属医院检验中心,河南郑州450002

出　　处：《国际检验医学杂志》2023年第23期2864-2867,2873,共5页International Journal of Laboratory Medicine

基　　金：国家自然科学基金项目(82002199)。

摘　　要：目的分析血脂相关指标甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白(Apo)A1、ApoB100、非高密度脂蛋白胆固醇(Non-HDL-C)、小而密低密度脂蛋白胆固醇(sdLDL-C)和同型半胱氨酸(Hcy)在急性缺血性脑卒中(AIS)中的应用价值。方法选取2018年7月至2023年2月于河南省人民医院就诊的脑卒中患者240例为研究对象,其中AIS 121例(缺血组),出血性脑卒中119例(出血组)。选取同期该院体检健康者113例作为健康对照组。采用生化分析仪检测TG、TC、HDL-C、LDL-C、ApoA1、ApoB100、Hcy、sdLDL-C水平;采用Logistic回归分析对危险因素进行评估;采用受试者工作特征(ROC)曲线下面积(AUC)评价各指标诊断效能。结果缺血组TC、LDL-C、ApoB100、Non-HDL-C、sdLDL-C、Hcy水平高于出血组和健康对照组,差异有统计学意义(P<0.05);出血组Hcy水平高于健康对照组,差异有统计学意义(P<0.05)。Non-HDL-C、Hcy水平是AIS发生的独立危险因素(P<0.05);ROC曲线结果显示,Non-HDL-C与Hcy联合应用辅助诊断AIS的AUC为0.870(95%CI 0.823~0.917,P<0.001),灵敏度为69.4%,特异度为94.7%,阳性预测值为83.3%,阴性预测值为75.4%,明显高于Hcy及Non-HDL-C单独检测。结论Non-HDL-C和Hcy水平是AIS发生的独立危险因素,二者联合应用在AIS中有较高辅助诊断价值,值得临床推广。Objective To analyze the application value of triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein(Apo)A1,ApoB100,non-high density lipoprotein cholesterol(Non-HDL-C),small dense low density lipoprotein cholesterol(sdLDL-C)and homocysteine(Hcy)in acute ischemic stroke(AIS).Methods A total of 240 stroke patients admitted to Henan Provincial People's Hospital from July 2018 to February 2023 were selected as the study subjects,including 121 cases of AIS(ischemic group)and 119 cases of hemorrhagic stroke(hemorrhage group).A total of 113 healthy people in the same hospital were selected as the healthy control group.The levels of TG,TC,HDL-C,LDL-C,ApoA1,ApoB100,Hcy and sdLDL-C were detected by biochemical analyzer.Logistic regression analysis was used to evaluate the risk factors.The area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the diagnostic efficacy of each index.Results The levels of TC,LDL-C,ApoB100,Non-HDL-C,sdLDL-C and Hcy in ischemic group were significantly higher than those in hemorrhage group and healthy control group(P<0.05).The level of Hcy in hemorrhage group was significantly higher than that in healthy control group(P<0.05).The levels of Non-HDL-C and Hcy were independent risk factors for AIS(P<0.05).ROC curve results showed that the AUC of Non-HDL-C combined with Hcy in the diagnosis of AIS was 0.870(95%CI 0.823-0.917,P<0.001),the sensitivity was 69.4%,the specificity was 94.7%,the positive predictive value was 83.3%,and the negative predictive value was 75.4%.It was significantly higher than that of Hcy and Non-HDL-C alone.Conclusion The levels of Non-HDL-C and Hcy are the independent risk factors of AIS.The combined application of non-HDL-C and Hcy has a high auxiliary diagnostic value in AIS,which is worthy of clinical promotion.

关 键 词：非高密度脂蛋白胆固醇 同型半胱氨酸 急性缺血性脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]