缺血性脑卒中患者入院时血清残余胆固醇水平与出院后死亡风险的关联研究  

Association study between serum residual cholesterol level at admission and the risk of death after discharge in patients with ischemic stroke

作　　者：任占云[1] 顾诗渊 吴恺迪 张湘楠 韩宁莉 牟佳龄 沈冲[2] REN Zhanyun;GU Shiyuan;WU Kaidi(Department of Neurology,Yixing People's Hospital,Yixing 214200,China)

机构地区：[1]宜兴市人民医院神经内科,214200 [2]南京医科大学公共卫生学院

出　　处：《临床神经病学杂志》2025年第1期1-10,共10页Journal of Clinical Neurology

基　　金：国家自然科学基金项目(81872686)。

摘　　要：目的探讨缺血性脑卒中(IS)患者入院时的残余胆固醇(RC)水平与出院后死亡风险的关系。方法选取35~80岁的IS患者2021例为研究对象,收集出院后死亡终点数据。采用限制性立方样条(RCS)回归,分析患者入院时RC水平与死亡结局发生风险的剂量-反应关系。利用Cox回归计算风险比(HR)与95%CI,分析IS患者入院时RC水平与出院后死亡风险的关联。结果根据RCS模型,RC水平与IS死亡和其他原因死亡具有非线性关联(P<0.001)。以RC水平的中位数为截断值,将研究对象分为低水平RC组(RC<0.72 mmol/L)和高水平RC组(RC≥0.72 mmol/L)。与高水平RC组相比,低水平RC组年龄、男性比率显著升高,空腹血糖(GLU)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A-1(ApoA-1)、载脂蛋白B(ApoB)水平及TG/HDL-C、TG/HDL-C、LDL-C/HDL-C、糖尿病比率均显著降低(P<0.05~0.01)。Cox回归分析显示,未调整协变量时,与低水平RC组相比,高水平RC组呈现出较低的全因死亡风险(HR=0.765,95%CI:0.619~0.946,P=0.013)和较低的IS死亡风险(HR=0.638,95%CI:0.435~0.936,P=0.022);调整性别、年龄、吸烟史、饮酒史、高血压病史、糖尿病病史后,高水平组仍然呈现出较低的全因死亡风险(HR=0.760,95%CI:0.614~0.941,P=0.012)和较低的IS死亡风险(HR=0.653,95%CI:0.444~0.961,P=0.031)。男性(HR=0.753,95%CI:0.572~0.990,P=0.042)、年龄≥65岁(HR=0.755,95%CI:0.594~0.959,P=0.021)、非吸烟(HR=0.746,95%CI:0.590~0.943,P=0.014)、非饮酒(HR=0.735,95%CI:0.588~0.919,P=0.007)、合并高血压病(HR=0.738,95%CI:0.580~0.940,P=0.014)、不合并糖尿病(HR=0.724,95%CI:0.561~0.934,P=0.013)患者中,高水平RC(≥0.72 mmol/L)与全因死亡风险降低关联具有统计学意义。年龄≥65岁(HR=0.598,95%CI:0.391~0.916,P=0.018)、非吸烟(HR=0.628,95%CI:0.408~0.967,P=0.035)、非饮酒(HR=0.656,95%CI:0.439~0.979,P=0.039)、不合并高血压病(HR=0.321,95%CI:0.108~0.95Objective Exploring the relationship between residual cholesterol(RC)levels at admission and the risk of death after discharge in patients with ischemic stroke(IS).Methods Select 2021 IS patients aged 35-80 as the research subjects,and collect endpoint data on mortality after discharge.Using restricted cubic spline(RCS)regression,analyze the dose-response relationship between RC levels at admission and the risk of mortality outcomes in patients.Using Cox regression to calculate hazard ratio(HR)and 95%CI,analyze the association between RC levels at admission and mortality risk after discharge in IS patients.Results According to the RCS model,there is a non-linear correlation between RC levels and deaths from IS and other causes(P<0.001).Using the median RC level as the cutoff value,the study subjects were divided into low-level RC group(RC<0.72 mmol/L)and high-level RC group(RC≥0.72 mmol/L).Compared with those in high level RC group,the age and male ratio in the low level RC group were significantly increased,and the levels of fasting blood glucose(GLU),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),non high-density lipoprotein cholesterol(HDL-C),apolipoproteins A-1(ApoA-1),apolipoproteins B(ApoB),TG/HDL-C,TG/HDLC,LDL-C/HDL-C and diabetes ratio were significantly decreased(P<0.05-0.01).Cox regression analysis showed that,when the covariates were not adjusted,compared with the low level RC group,the high level RC group showed a lower risk of all-cause death(HR=0.765,95%CI:0.619-0.946,P=0.013)and a lower risk of IS death(HR=0.638,95%CI:0.435-0.936,P=0.022);after adjusting for gender,age,smoking history,drinking history,hypertension history and diabetes history,the high level RC group still showed a lower risk of all-cause death(HR=0.760,95%CI:0.614-0.941,P=0.012)and lower IS mortality risk(HR=0.653,95%CI:0.444-0.961,P=0.031).Male(HR=0.753,95%CI:0.572-0.990,P=0.042),age≥65 years old(HR=0.755,95%CI:0.594-0.959,P=0.021),non-smoking(HR=0.746,95%CI:0.590-0.943,P=0.014),nondrinking(H

关 键 词：脑卒中 缺血性脑卒中 血脂水平 残余胆固醇 死亡风险 

分 类 号：R743.3[医药卫生—神经病学与精神病学]