血浆低密度脂蛋白水平与脑出血患者血肿增大和转归的相关性：回顾性队列研究

Correlation between plasma low-density fipoprotein levd and hematoma enlargement and outcome in patients with intracerebral hemonhage： A retrospective cohort study

目的 探讨血浆低密度脂蛋白（low-density lipoprotein,LDL）水平与脑出血早期血肿增大以及3个月时临床转归和死亡的关系.方法 纳入原发性脑出血患者316例,记录其一般资料,在起病6h内及24 h行CT扫描,同时检测血脂、血糖、血压以及美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分.随访3个月,记录其改良Rankin量表（modified RankinScale, mRS）评分及死亡例数.结果 血浆LDL水平降低[优势比（odds ratio,OR）0.323,95％可信区间（confidence interval,CL）0.128～0.819；P=0.017]和收缩压增高（OR l.015,95％ CI 1.000～1.029;P =0.043）与脑出血早期血肿增大独立相关.血浆LDL水平降低（OR 0.253,95％CI 0.102～0.629;P=0.003）和血糖水平增高（OR 1.458,95％ CI 1.257～1.693；P＜0.001）是发病3个月时的临床转归不良的独立因素.血浆LDL水平降低（OR 0.211,95％ CI 0.075～0.597;P=0.003）、血糖水平增高（OR 1.406,95％ CI 1.212～1.632;P=0.001）和收缩压增高（OR 1.026,95％ CI 1.009～1.043;P=0.002）是3个月内死亡的独立危险因素.受试者工作特征曲线显示,LDL水平＜2.58 mmol/L是血肿增大的独立预测因素（敏感性71.79％,特异性64.71％,阳性预测值40.00％,阴性预测值87.50％）.结论 血浆LDL水平降低是原发性脑出血患者早期血肿增大、3个月时转归不良和死亡的独立预测因素.

Objective To investigate the relationship between plasma low-density lipoprotein （LDL） levels and hematoma enlargement of early intracerebral hemorrhage,outcome at 3 months and death.Methods A total of 316 patients with primary intracerebral hemorrhage were included in the study.Their general information was documented.The patients underwent CT scans at 6 and 24 hours after onset.The lipids,blood glucose,blood pressure,and the National Institutes of Health Stroke Scale （NIHSS） scores were detected at the same time.The patients were followed up for 3 months and their modified Rankin scale （mRS） scores and the number of death were recorded.Results The decreased plasma LDL level （odds ratio [OR] 0.323,95% confidence interval [CI] 0.128 - 0.819; P =0.017） and the increased systolic pressure （OR 1.015,95% CI 1.000 -1.029; P =0.043） were independently associated with the early hematoma enlargement.The decreased plasma LDL level （OR 0.253,95% CI 0.102-0.629; P=0.003） and the increased blood glucose （OR 1.458,95% CI 1.257 - 1.693; P 〈 0.001 ） were the independent risk factors for poor outcome at 3 months after onset.The decreased plasma LDL level （OR 0.211,95% CI 0.075 - 0.597; P =0.003）,the increased bloot glucose level （OR 1.406,95% CI 1.212 - 1.632; P =0.001） and the increased blood glucose level （OR 1.026,95% CI 1.009 - 1.043; P =0.002） were the independent risk factors for death within 3 months.Receiver operating characteristic curves showed that the LDL level 〈 2.58 mmol/L was an independent predictor for hematoma enlargement （sensitivity 71.79%,specificity 64.71%,positive predictive value 40.00%,and negative predictive value 87.50% ）.Conclusion The decreased plasma LDL level was the independent predictor for early hematoma enlargement,poor outcome and death at 3 months in patients with primary intracerebral hemorrhage.