血浆致动脉粥样硬化指数对新发缺血性脑卒中的影响  

Impact of the atherogenic index of plasma on new-onset ischemic stroke

作　　者：吕素洁 吴寿岭[1] 李金锋[1] 朱辰蕊[1] 王艳丽[2] 季春鹏[1] Lyu Sujie;Wu Shouling;Li Jinfeng;Zhu Chenrui;Wang Yanli;Ji Chunpeng(Department of Cardiology,Kailuan General Hospital,Tangshan 063000,China;Intensive Care Unit,Kailuan General Hospital,Tangshan 063000,China)

机构地区：[1]开滦总医院心内科,唐山063000 [2]开滦总医院重症医学科,唐山063000

出　　处：《中国心血管杂志》2024年第3期198-204,共7页Chinese Journal of Cardiovascular Medicine

摘　　要：目的 探讨基线血浆致动脉粥样硬化指数(AIP)对新发缺血性脑卒中的影响。方法 采用前瞻性队列研究方法,选取2006年7月至2007年10月参加健康体检、既往无脑卒中病史、资料完整的97680名开滦集团公司职工作为观察队列,随访至2020年12月31日,以新发缺血性脑卒中作为终点事件。根据基线AIP三分位数将研究人群分为3组,T_(1)组32574名(AIP<-0.18)、T_(2)组33033名(-0.18≤AIP<0.06)和T_(3)组32073名(AIP≥0.06)。根据寿命表法计算各组缺血性脑卒中的累积发病率,并采用log-rank检验比较组间差异。采用多因素Cox比例风险回归模型分析基线AIP对新发缺血性脑卒中的影响。结果 在平均随访(13.7±1.7)年后,共有5822例研究对象发生缺血性脑卒中。随基线AIP三分位数分组递增,新发缺血性脑卒中的累积发病率呈递增趋势,T_(1)、T_(2)和T_(3)组分别为4.8%、5.8%和7.2%(^(χ2)=143.97,P<0.001)。在校正相关混杂因素后,多因素Cox回归分析结果显示,基线AIP每增加一个标准差(0.29),新发缺血性脑卒中的风险增加36%(HR=1.36,95%CI:1.23~1.50,P<0.001);与T_(1)组比较,T_(2)和T_(3)组新发缺血性脑卒中的风险分别增加12%(HR=1.12,95%CI:1.04~1.20,P<0.001)和26%(HR=1.26,95%CI:1.18~1.36,P<0.001)。进一步分析发现,在随访至第2年时,在校正相关混杂因素后,不同基线AIP三分位数分组之间新发缺血性脑卒中的风险差异并无统计学意义;而在随访至第4年时,T_(3)组新发缺血性脑卒中风险显著高于T_(1)组(HR=1.24,95%CI:1.06~1.46,P=0.009)。结论 AIP增加是新发缺血性脑卒中的独立危险因素,而且此种致病效应可能在早期(2~4年)即开始显现。Objective To investigate the impact of baseline atherogenic index of plasma(AIP) on new-onset ischemic stroke.Methods This was a prospective cohort study.A total of 97680 employees without previous stroke participated in the health examination from 2006 to 2007 were enrolled and followed until December 31,2020.The primary endpoint was new-onset ischemic stroke.The study population was divided into three groups according to tertiles of the baseline AIP(T_(1) group:AIP<-0.18;T_(2) group:-0.18≤AIP<0.06;T_(3) group:AIP ≥ 0.06).The cumulative incidence of new-onset ischemic stroke was calculated using the life-table method and compared using the Log-rank test.Multivariate cox regression models were used to analyze the effect of baseline AIP on new-onset ischemic stroke.Results A total of 5822 cases of new-onset ischemic stroke occurred after a mean follow-up of 13.7 ± 1.7 years.The cumulative incidence of new-onset ischemic stroke increased with the baseline AIP tertiles,which was 4.8%,5.8% and 7.2%,respectively(P<0.001).After adjusting for confounders,the risk of new-onset ischemic stroke increased by 36%(HR= 1.36,95%CI:1.23-1.50,P<0.001) for each one standard deviation(0.29) increase in baseline AIP.Compared with the participants in T_(1) group,the risk of newonset ischemic stroke increased by 12%(HR= 1.12,95%CI:1.04-1.20,P<0.001) and 26%(HR=1.26,95%CI:1.18-1.36,P<0.001) among those in T_(2) and T_(3) group,respectively.Further analysis showed that there was no significant difference in the risk of new-onset ischemic stroke among differenttertiles of AIP after adjusting for above confounders in the second year of the follow-up.But in the fourthyear of the follow-up,the risk of new-onset ischemic stroke in T_3,group was significantly higher than that inT,group ( HR=1.24,95% CI:1.06-1.46,P=0.009).Conclusions Elevated AIlP is an independent risk factor for new-onset ischemic stroke,and its pathogenic effects may manifest as early as within 2 to 4 years.

关 键 词：缺血性脑卒中 动脉粥样硬化 血浆致动脉粥样硬化指数 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]