血脂指标的比值在预测心脑疾病患者颈动脉内-中膜增厚中的作用

Effectiveness of lipds ratio as a predictor of increased carotid intima-media thickness patients with cardio-cerebrovascular diseases

目的评价颈动脉内-中膜厚度(CIMT)与血脂(包括脂质、脂蛋白、载脂蛋白)、超敏C反应蛋白(hs-CRP)、空腹血糖、年龄、性别等因素间的相关性。方法回顾性分析2009年9月—2010年3月在广州市红十字会医院神经内科和心内科住院,年龄≥40岁的833例患者的临床资料,包括采用超声测量的平均CIMT、性别、年龄、血脂水平[脂质、脂蛋白、载脂蛋白,以及脂质比值,包括低密度脂蛋白胆固醇(LDL-C)与高密度脂蛋白胆固醇(HDL-C)的比值、载脂蛋白B(Apo-B)与载脂蛋白A-Ⅰ(ApoA-Ⅰ)的比值及总胆固醇(TC)与HDL-C的比值]、hs-CRP、空腹血糖等资料。依据患者的CIMT,分为正常组(平均CIMT<1.0 mm)172例,增厚组(平均CIMT≥1.0 mm)661例。采用二元Logistic回归分析筛选出CIMT增厚的独立危险因素。结果①增厚组患者的年龄、空腹血糖、hs-CRP、LDL-C/HDL-C比值、TC/HDL-C比值、Apo-B/ApoA-Ⅰ比值的中位数,均高于正常组,而HDL-C、ApoA-Ⅰ的中位数低于正常组。增厚组男性例数要明显多于正常组,差异有统计学意义,均P<0.05。两组之间其他变量差异无统计学意义。②二元Logistic回归显示,年龄(OR=1.085,95%CI:1.067～1.104)、男性(OR=1.897,95%CI:1.985～2.799)、hs-CRP(OR=1.165,95%CI:1.047～1.296)、LDL-C/HDL-C比值(OR=1.281,95%CI:1.040～1.579)是预测CIMT增厚的独立危险因素。结论 LDL-C/HDL-C比值增高是预测心脑疾病患者CIMT增厚的独立危险因素,其预测作用可能要优于单独检测LDL-C或HDL-C。

Objective To evaluate the correlations between carotid intima-media thickness（CIMT） and blood lipids（including lipids,lipoproteins and apolipoproteins）,high sensitivity C-reactive protein（hs-CRP）,fasting glucose,age,and sex et al.Methods The clinical data of 833 patients aged ≥ 40 years of age in the Departments of Neurology and Cardiology,the Affiliated Dongguan Hospital,School of Medicine,Jinan University from September 2009 to March 2010 were analyzed retrospectively,including ultrasound-derived mean CIMT,age,sex,the levels of serum lipids（including lipids,lipoprotein,apolipoprotein,and lipids ratio,such as LDL-C/HDL-C,total cholesterol/HDL-C,apolipoprotein B/apolipoprotein A1 ratio）,hs-CRP,fasting glucose.The patients were divided into either a normal group（the mean CIMT 1.0 mm,n=172） or a thickening group（the mean CIMT ≥ 1.0 mm,n=661） according to their CIMT.A binary logistic regression analysis was use to identify the independent risk factors for increased CIMT.Results ①The median of age,fasting glucose,hs-CRP,low-density lipoprotein cholesterol/high density lipoprotein cholesterol（LDL-C/HDL-C） ratio,total cholesterol（TC）/HDL-C ratio,and apolipoprotein B/apolipoprotein A-Ⅰ ratio in the thickening group were significantly higher than those in the normal group,and the median of HDL-C and apolipoprotein A-Ⅰ were lower than those in the normal group.The number of men in the thickening group was obviously more than that in the normal group.There was significant differences（all P0.05）.There were no significant differences in other variables between the 2 groups.②Binary logistic regression analysis showed that significant risk factors associated with increased CIMT were age（OR,1.085,95%CI 1.067-1.104）,man（OR,1.897,95%CI 1.985-2.799）,hs-CRP（OR,1.165,95%CI 1.047-1.296）,and LDL-C/HDL-C ratio（OR,1.281,95%CI 1.040-1.579）.Conclusion The age,male,hs-CRP,and LDL-C/HDL-C ratio were the independent risk factors for increased CIMT.LDL-C/HDL-C in the prediction of increased CIMT may be superior to the separate detection of LDL-C or HDL-C.