血清低密度脂蛋白胆固醇与急性自发性脑出血患者血肿增大、早期神经功能恶化和转归的相关性  

Associations of serum low-density lipoprotein cholesterol with hematoma enlargement,early neurological deterioration,and outcome in patients with acute spontaneous intracerebral hemorrhag

作　　者：兰婷 郝喜娃[2] 吕琳[2] 张翠琴 乔红梅 张波波 陈永明 薄启迪 闫美佑 吕慧 张京芬[2] Lan Ting;Hao Xiwa;Lyu Lin;Zhang Cuiqin;Qiao Hongmei;Zhang Bobo;Chen Yongming;Bo Qidi;Yan Meiyou;Lyu Hui;Zhang Jingfen(Baotou Clinical Medical College,Inner Mongolia Medical University,Baotou 014040,China;Department of Neurology,Baotou Central Hospital,Inner Mongolia Clinical Medical Research Center for Neurological Diseases,Baotou 014040,China;People's Hospital of Wuyuan County,Bayannur 015100,China)

机构地区：[1]内蒙古医科大学包头临床医学院,包头014040 [2]包头市中心医院神经内科,内蒙古自治区神经系统疾病临床医学研究中心,包头014040 [3]内蒙古自治区五原县人民医院,巴彦淖尔015100

出　　处：《国际脑血管病杂志》2024年第7期506-511,共6页International Journal of Cerebrovascular Diseases

基　　金：内蒙古自治区神经系统疾病临床医学研究中心专项匹配资金。

摘　　要：目的探讨血清低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)与自发性脑出血(intracerebral hemorrhage,ICH)患者血肿增大(hematoma enlargement,HE)、早期神经功能恶化(early neurological deterioration,END)和转归的相关性。方法利用"内蒙古地区自发性脑出血多中心登记研究"(注册号:ChiCTR2000029494)数据库纳入2020年6月至2022年9月期间登记的在发病后6 h内完成首次头颅CT,在发病24 h内进行血脂检查、CT复查并使用3D Slicer软件准确测量血肿体积的ICH患者。HE定义为24 h时血肿体积增加>33%或>6 ml,血肿破入脑室时HE定义为脑室血肿体积较基线增加≥1 ml。END定义为发病后24 h内美国国立卫生研究院卒中量表评分较基线增加≥4分或死亡。在发病后3个月时进行随访,改良Rankin量表评分>2分定义为转归不良。应用多变量logistic分析确定LDL-C与HE、END和转归的独立相关性。结果共纳入338例ICH患者,男性206例(60.9%),LDL-C为(2.39±1.22)mmol/L。88例(26.0%)发生HE,67例(19.8%)发生END,162例(47.9%)3个月时转归不良。多变量logistic分析显示,校正混杂因素后,LDL-C与HE(优势比0.312,95%置信区间0.208~0.467;P<0.001)和END(优势比0.408,95%置信区间0.275~0.606;P<0.001)存在显著独立负相关联系,但与3个月时转归无关。结论LDL-C较低与ICH患者的HE和END相关,但与转归无关。ObjectiveTo investigate associations of serum low-density lipoprotein cholesterol(LDL-C)with hematoma enlargement,early neurological deterioration(END),and outcome in patients with acute spontaneous intracerebral hemorrhage(ICH).Methods"A multi-center registration study for spontaneous intracerebral hemorrhage in Inner Mongolia"(registration number:ChiCTR2000029494)database was used to include patients with ICH who completed their first head CT scan within 6 hours after onset,underwent blood lipid examination,CT follow-up within 24 hours of onset,and accurately measured hematoma volume using 3D Slicer software between June 2020 and September 2022.HE was defined as hematoma volume increasing>33%or>6 ml at 24 hours,or ventricular hematoma volume increasing≥1 ml compared to the baseline.END was defined as an increase of≥4 in the National Institutes of Health Stroke Scale(NIHSS)score from the baseline or death within 24 hours after onset.The follow-up was conducted at 3 months after onset,and the modified Rankin Scale score>2 was defined as poor outcome.Multivariate logistic analysis was used to determine the independent correlation between LDL-C and HE,END,and outcome.ResultsA total of 338 patients with ICH were enrolled,including 206 males(60.9%).LDL-C was 2.39±1.22 mmol/L.Eighty-eight patients(26.0%)developed HE,67(19.8%)developed END,and 162(47.9%)had poor outcome at 3 months.Multivariate logistic analysis showed that after adjusting for confounding factors,there was a significant independent negative correlation between LDL-C and HE(odds ratio 0.312,95%confidence interval 0.208-0.467;P<0.001)and END(odds ratio 0.408,95%confidence interval 0.275-0.606;P<0.001),but not with the outcome at 3 months.ConclusionLower LDL-C is associated with HE and END in patients with ICH,but not with the outcome.

关 键 词：脑出血 血肿 胆固醇 LDL 体层摄影术 X线计算机 疾病恶化 治疗结果 

分 类 号：R743.34[医药卫生—神经病学与精神病学]