摘要
目的分析缺血性脑卒中(IS)患者血清高密度脂蛋白3亚型胆固醇(HDL3-C)水平,探讨其对患者病情和预后评估的临床价值。方法连续选取2023年1月至6月于东部战区总医院神经内科确诊的IS患者124例和健康对照者47例,检测研究对象血清HDL3-C、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及血糖(Glu)、白蛋白(Alb)、白介素6(IL-6)、降钙素原(PCT)水平;计算IS患者入院时的美国国立卫生研究院卒中量表(NIHSS)评分、出院时的改良Rankin量表(MRS)和Barthel指数(BI)评分;IS患者随访1年,详细记录其卒中后遗症及再次发生急性脑血管事件的发生时间。采用Spearman相关性分析探讨IS患者血清HDL3-C水平与其他临床、生化参数的相关性;采用Logistic回归分析血清HDL3-C评估IS发生风险的临床价值。采用Cox回归分析血清HDL3-C评估IS患者预后的临床价值。结果与对照组相比,IS组患者血清HDL3-C、HDL-C和Alb水平降低(P均<0.05),但TG、Glu水平均升高(P均<0.05)。IS患者血清HDL3-C水平与TC(r=0.231,P=0.003)、HDL-C(r=0.831,P<0.001)、Alb(r=0.451,P<0.001)及出院BI评分(r=0.216,P=0.018)呈正相关,而与TG(r=-0.396,P<0.001)、IL-6(r=-0.290,P=0.013)及入院NIHSS评分(r=-0.187,P=0.041)、出院MRS评分(r=-0.227,P=0.012)呈负相关。多因素Logistic回归分析显示,校正年龄、性别和TC、TG、LDL-C、HDL-C水平的影响后,低HDL3-C(OR=0.853,95%CI=0.740~0.984,P=0.030)水平仍然与IS发生风险独立相关。Cox回归多因素分析显示,校正年龄、性别及TC、TG、HDL-C、LDL-C的影响后,降低的初始HDL3-C水平仍然与IS患者预后不良独立相关(HR=0.710,95%CI=0.517~0.976,P=0.035)。结论IS患者血清HDL3-C水平降低,且与预后不良独立相关;HDL3-C对评估IS患者病情及预后有一定的参考价值。
Objective To analyze the serum high-density lipoprotein 3 subtype cholesterol(HDL3-C)levels in patients with ischemic stroke(IS)and explore its clinical value in evaluating the condition and prognosis.Methods A total of 124 patients with IS and 47 healthy controls admitted to the Department of Neurology of the General Hospital of the Eastern Theater Command were continuously selected from January to June 2023.The serum samples of IS patients at admission and healthy controls were collected respectively,and the levels of HDL3-C,total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),blood glucose(Glu),albumin(Alb),interleukin 6(IL-6)and procalcitonin(PCT)were measured.The National Institutes of Health Stroke Scale(NIHSS)score at admission,modified Rankin Scale(MRS)score at discharge,and Barthel index of the IS patients were calculated.All the IS patients were followed up for 1 year.The time of sequelae caused by stroke,and recurrence of acute cerebrovascular events were recorded in detail.Spearman's correlation analysis was used to explore the correlation between HDL3-C levels and other clinical events and biochemical parameters in the IS patients.Logistic regression analysis was used to analyze the clinical value of serum HDL3-C levels in evaluating the presence of IS.Cox regression analysis was used to analyze the clinical value of serum HDL3-C levels in assessing the prognosis of patients with IS.Results Compared with controls,the levels of HDL3-C,HDL-C and Alb of the patients with IS decreased significantly,but the levels of TG and Glu of the IS patients increased significantly(all P<0.05).The level of serum HDL3-C in patients with IS was significantly positively correlated with TC(r=0.231,P=0.003),HDL-C(r=0.831,P<0.001),Alb(r=0.451,P<0.001)and Barthel index at discharge(r=0.216,P=0.018),while it was significantly negatively correlated with the levels of TG(r=-0.396,P<0.001),IL-6(r=-0.290,P=0.013),NIHSS at admission(r=-0.187,P=0.041)and MRS at discharge(r=-0.227,P=0.012).Multivariate Logistic regression analyses showed that the decreased level of serum HDL3-C was still independently related to the presence of IS(OR=0.853,95%CI=0.740-0.984,P=0.030)after adjusting for the fectors of age,sex,TC,TG,HDL-C and LDL-C.Multivariate Cox regression analyses demonstrates that the decreased level of serum HDL3-C was still independently related to the poor prognosis of IS patients(HR=0.710,95%CI=0.517-0.976,P=0.035)after adjusting for the fectors of age,sex,TC,TG,HDL-C and LDL-C.Conclusion The level of serum HDL3-C in patients with IS decreased significantly,and it is independently correlated with poor prognosis.The level of HDL3-C has reference value in evaluating the condition and prognosis of the patients with IS.
作者
于晓阳
吴嘉
顾卓蓥
汪俊军
YU Xiaoyang;WU Jia;GU Zhuoying;WANG Junjun(Medical School of Jiangsu University,Zhenjiang 212013,Jiangsu;Department of Clinical Laboratory,General Hospital of Eastern Theater Command,Nanjing 210002,Jiangsu,China)
出处
《临床检验杂志》
2025年第6期410-415,共6页
Chinese Journal of Clinical Laboratory Science
基金
国家自然科学基金(81871702,82172360)
江苏省科教能力提升工程省医学重点学科资助项目(ZDXK202238)
东部战区总医院临床诊疗新技术项目(22LCZLXJS20)。
