总胆固醇及甘油三酯与卒中亚型关系的前瞻性研究

Prospective study on associations between levels of total cholesterol, triglyceride and risk of ischemic and hemorrhagic strokes

目的研究人群总胆固醇（TC）、甘油三酯（TG）水平与缺血性和出血性卒中发病的关系。方法1987年5至7月，对在北京等5个城市社区所选取的35岁以上无卒中队列人群进行卒中危险因素调查和体格检查，1998至2000年对人选的队列人群进行全面复查，共10093例完成基线血脂调查及队列随访。采用Cox回归模型估计基线TC和TG中、高三分位组缺血性与出血性卒中发病的相对危险度（风险比，HR）和95％可信区间（95％CI）。结果平均随访8年，新发卒中491例。舒张压模型调整舒张压、年龄和性别等多因素后，与低TC组相比，中、高TC组缺血性卒中发病风险分别增加61％（HR：1．61，95％CI：1．14～2．27）和58％（HR：1．58，95％CI：1．12～2．22）。与低TG组相比，高TG组缺血性卒中发病风险增加43％（HR：1．43，95％CI：1．02～2．00）。TC与出血性卒中呈负相关，与低TC组相比，中、高TC组人群出血性卒中发病的危险分别减少了12％（HR：0．88，95％CI：0．64～1．22）和33％（HR：0．67，95％CI：0．48—0．95）。结论血清TC和TG升高均为缺血性卒中发病独立危险因素。但TC过低却增加出血性卒中的发病风险。

Objective To explore associations between levels of total cholesterol （TC）, triglyceride （TG） and incidence of ischemic and hemorrhagic strokes in populations. Methods Baseline investigations on stroke-related risk factors and physical examinations were performed in 10 093 （ 〉 35 years） stroke-free urban community residents from 5 cities in China during May to July in 1987, follow-up investigations on stroke events were made during 1998 to 2000. The hazard ratios and 95% confidence intervals （CI） of ischemic and hemorrhagic strokes in middle, high tertiles of baseline TC or TG levels were compared with low baseline tertile residents using the Cox regression model. Results There were 491 first strokes during the 8-years cohort follow-up. Compared with the low tertile, risk of ischemic stroke in the middle and high terti]es of TC level was increased by61% （HR： 1.61, 95%C1：1.14 -2. 27） and 58% （HR： 1.58, 95% CI： 1.12-2. 22） after adjustments for DBP, age, sex and other variables in the Cox proportional hazards model. Compared with the low tertile, risk of isehemic stroke in the high tertile of TG level was increased by 43% （HR： 1.43, 95% CI： 1.02- 2. 00）. However, risk of hemorrhagic stroke in the middle and high tertiles of TC level decreased by 12% （HR： O. 88, 95% CI： 0. 64 - 1.22） and 33% （HR： O. 67, 95% CI： 0. 48 -0. 95） compared with the low tertile. Conclusions Elevated serum TC and TG are independent risk factors for risk of ischemic stroke. However, low TC was related with increased risk of hemorrhagic stroke.