不同预后急性脑梗死患者血脂代谢及临床干预意义  

Lipid metabolism in patients with acute cerebral infarction of different prognosis and its clinical intervention significance

作　　者：陈蕊 徐江 田英慧 范丽丽 CHEN Rui;XU Jiang;TIAN Yinghui;FAN Lili(First Hospital of Qinhuangdao,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院,河北秦皇岛066000

出　　处：《中国实用神经疾病杂志》2024年第12期1459-1464,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河北省医学科学研究重点课题计划项目(编号:20220195)。

摘　　要：目的分析不同预后急性脑梗死(ACI)患者血脂代谢情况及临床干预意义。方法选取2020-08—2023-08秦皇岛市第一医院收治的178例ACI患者,分析患者预后、血脂总体情况,进一步对比不同预后患者血脂指标[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)]、新型血脂指标[TC/HDL-C、非高密度脂蛋白胆固醇(non-HDL-C)、LDL-C/HDL-C、TG/HDL-C、残余胆固醇(RC)],采用Logistic回归分析血脂与ACI预后的相关性,用四分位数法将LDL-C、non-HDL-C、TC/HDL-C、TC/HDL-C、RC分层,进一步分析各指标与ACI预后的相关性。结果不同神经功能缺损程度、血管再通情况、侧支循环情况(TC、RC除外)、功能预后患者TG、LDL-C、TC、HDL-C、non-HDL-C、TC/HDL-C、LDL-C/HDL-C、TG/HDL-C、RC比较,差异有统计学意义(P<0.05)。多因素分析显示,LDL-C与神经功能缺损程度显著相关(P<0.05),其余传统指标与神经功能缺损、血管再通、侧支循环、功能预后无关(P>0.05);LDL-C/HDL-C与神经功能缺损、血管再通、侧支循环、功能预后无关(P>0.05),non-HDL-C、TC/HDL-C、TG/HDL-C均与神经功能缺损、血管再通、侧支循环、功能预后相关(P<0.05),RC与神经功能缺损、功能预后相关(P<0.05);进一步分层多因素显示,LDL-C>3.12 mmol/L可将重度神经功能缺损风险提高1.231倍(P<0.05),non-HDL-C、TC/HDL-C、TG/HDL-C、RC均会增加重度神经功能缺损、血管再通不良、侧支循环不良及不良功能预后的风险(P<0.05)。结论传统血脂指标LDL-C、新型血脂指标non-HDL-C、TC/HDL-C、TG/HDL-C、RC异常升高可增加患者重度神经功能缺损、血管再通不良、侧支循环不良及不良功能预后发生风险,检测其水平变化可为ACI患者血脂干预提供参考。Objective To analyze the lipid metabolism of patients with acute cerebral infarction(ACI)with different prognosis and the significance of clinical intervention.Methods A total of 178 ACI patients admitted to the First Hospital of Qinhuangdao from August 2020 to August 2023 were selected,and the prognosis and overall lipid profile of the patients were analyzed.Furthermore,traditional lipid indexes[triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)],new lipid indexes[TC/HDL-C,non-HDL-C,LDL-C/HDL-C,TG/HDL-C,residual cholesterol(RC)]were further compared in patients with different prognosis,Logistic regression was used to analyze the relationship of blood lipid and ACI prognosis.LDL-C,non-HDL-C,TC/HDL-C,TC/HDL-C and RC were stratified by quartile method,and the relationship of each index and ACI prognosis was further analyzed.Results Comparison of TG,LDL-C,TC,HDL-C,non-HDL-C,TC/HDL-C,LDL-C/HDL-C,TG/HDL-C and RC in patients with different degree of nerve defect,vascular recirculation,collateral circulation(except TC and RC)and functional prognosis,the difference was statistically significant(P<0.05).Multivariate analysis showed that LDL-C was significantly correlated with the degree of nerve defect(P<0.05),while other traditional indexes were not correlated with nerve defect,vascular recanalization,collateral circulation and functional prognosis(P>0.05).LDL-C/HDL-C was not correlated with nerve defect,vascular recanalization,collateral circulation,and functional prognosis(P>0.05),while non-HDL-C,TC/HDL-C,TG/HDL-C were correlated with nerve defect,vascular recanalization,collateral circulation,and functional prognosis(P<0.05).RC was associated with neurological defect and functional prognosis(P<0.05).Further stratification and multiple factors showed that LDL-C>3.12 mmol/L could increase the risk of severe nerve defect by 1.231 times(P<0.05),non-HDL-C,TC/HDL-C,TG/HDL-C,RC all increased the risk of severe nerve defect,poor vascular recirculation,

关 键 词：急性脑梗死 预后 血脂代谢 神经功能缺损 血管再通 侧支循环 

分 类 号：R743.33[医药卫生—神经病学与精神病学]