残余胆固醇累积暴露对卒中作用的前瞻性队列研究  

A prospective cohort study on the impact of remnant cholesterol cumulative exposure on stroke risk

作　　者：田恩宇 韩明辉 李建新[1] 曹杰[1] 刘芳超[1] 黄克勇 陈恕凤[1] 陈纪春[1] 黄建凤[1] 顾东风[1] 鲁向锋[1] TIAN Enyu;HAN Minghui;LI Jianxin;CAO Jie;LIU Fangchao;HUANG Keyong;CHEN Shufeng;CHEN Jichun;HUANG Jianfeng;GU Dongfeng;LU Xiangfeng(Chinese Academy of Medical Sciences and Peking Union Medical College,National Center for Cardiovascular Diseases,Department of Epidemiology,Fuwai Hospital,Key Laboratory of Cardiovascular Epidemiology,Beijing 102300,China;不详)

机构地区：[1]中国医学科学院北京协和医学院,国家心血管病中心,中国医学科学院阜外医院流行病研究部,中国医学科学院心血管流行病学重点实验室,北京102300 [2]河南省人民医院河南省肾病临床医学研究中心

出　　处：《中国预防医学杂志》2025年第2期157-163,共7页Chinese Preventive Medicine

基　　金：国家自然科学基金资助项目(82330106,82030102);中国医学科学院阜外医院高水平医院临床科研业务费(2022-GSP-GG-1,2022-GSP-GG-2);中国医学科学院医学与健康科技创新工程(2021-I2M-1-010)。

摘　　要：目的探讨残余胆固醇(remnant cholesterol,RC)累积暴露对卒中的影响。方法纳入中国动脉粥样硬化性心血管疾病风险预测项目中前瞻性队列的69802例研究对象,分别于1998—2015年进行了2~3次血脂检测。根据指南标准,按照RC和低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)累积暴露是否升高将人群分成四组。采用多因素logistic回归模型评估RC和LDL-C累积暴露对卒中及不同亚型的独立作用和联合效应。使用限制性立方样条拟合累积RC水平和卒中风险的剂量-反应关系。结果研究对象平均随访7.35年,发生卒中1553例,其中缺血性卒中1168例,出血性卒中311例。RC累积暴露与卒中风险呈现非线性关联(P非线性检验<0.001),累积RC和LDL-C水平每升高1个标准差,卒中的OR值(95%CI)分别为1.14(1.09~1.19,P<0.001)和1.12(1.06~1.18,P<0.001),二者对缺血性卒中作用更明显,但与出血性卒中的关联无统计学意义(P>0.05)。联合分组分析显示,LDL-C和RC累积暴露均升高组卒中风险最高(OR=1.57,95%CI:1.25~1.95,P<0.001),LDL-C正常但RC升高组卒中风险增加28%(OR=1.28,95%CI:1.09~1.49,P=0.002),而LDL-C升高但RC正常组却未观察到风险增加。结论相较于LDL-C,累积RC对卒中风险增加作用更强,并且不依赖于LDL-C水平的高低,提示卒中防治除了常规管理LDL-C外,应额外关注RC。Objective To investigate the effects of cumulative exposure to remnant cholesterol(RC)on the risk of stroke.Methods A total of 69802 participants from the Chinese Atherosclerosis Cardiovascular Disease Risk Prediction Project were included in this prospective cohort study,with 2 to 3 lipid profile assessments conducted between 1998 and 2015.Participants were stratified into four groups based on whether their RC and lowdensity lipoprotein cholesterol(LDL-C)levels were elevated according to guideline standards.Multivariate logistic regression models were employed to evaluate the independent effects and interactions of RC and LDL-C cumulative exposure on stroke and its subtypes.Restricted cubic splines were used to evaluate the dose-response relationship between cumulative RC levels and stroke risk.Results The average follow-up duration for participants was 7.35 years,during which 1553 strokes occurred,including 1168 ischemic strokes and 311 hemorrhagic strokes.A non-linear association was observed between cumulative RC exposure and stroke risk(P for nonlinearity<0.001).Each standard deviation increase in cumulative RC and LDL-C levels was associated with odds ratios(OR)for stroke of 1.14(1.09-1.19,P<0.001)and 1.12(1.06-1.18,P<0.001),respectively,with a more pronounced effect on ischemic stroke;however,no statistically significant association was found with hemorrhagic stroke(P<0.05).Joint group analysis indicated that the highest stroke risk was in the group with elevated both RC and LDL-C(OR=1.57,95%CI:1.25-1.95,P<0.001).In contrast,the group with normal LDL-C but elevated RC exhibited a 28%increase in stroke risk(OR=1.28,95%CI:1.09-1.49,P=0.002),while no increased risk was observed in the group with elevated LDL-C but normal RC.Conclusions Cumulative RC has a stronger association with increased stroke risk compared to LDL-C,independent of LDL-C levels.This finding suggests that,in addition to routine management of LDL-C,attention should also be given to RC in stroke prevention and treatment.

关 键 词：残余胆固醇 累积暴露 卒中 前瞻性队列研究 低密度脂蛋白胆固醇 

分 类 号：R181[医药卫生—流行病学] R54[医药卫生—公共卫生与预防医学]