高密度脂蛋白胆固醇与缺血性卒中复发的关系

Association of serum high.density lipoprotein cholesterol level and risk of recurrent ischemic stroke

目的探讨高密度脂蛋白胆固醇（HDL—C）与缺血性卒中复发的关系。方法2003年1月至2006年12月，对在北京市5家二级医院所属的社区卫生服务中心或服务站就诊的首次或二次缺血性卒中患者进行登记，共人选缺血性卒中患者1059例。基线调查后，每6个月随访1次，截止时间为2008年12月31日，记录卒中事件的发病情况。采用Cox回归分析不同HDL—C和HDL-C／总胆固醇（TC）水平患者缺血性卒中复发的风险。结果HDL．C升高（≥1．55mmol／L）、正常（1．04-1．54mmol／L）和降低（〈1．04mmol,／L）缺血性卒中患者的比例分别是15．58％（165／1059）、54．58％（578／1059）和29．84％（316／1059）。随访（3．21-i-1．04）年，共137例患者复发缺血性卒中。多因素Cox回归分析显示，与HDL-C≥1．40mmol／L患者比较，HDL—C≤1．00mmol／L和1．01-1．19mmol／L患者的缺血性卒中复发率分别增加了0．944倍（HR=1．944，95％CI：1．033—3．659，P=0．039）和1．027倍（HR=2．027，95％CI：1．116-3．682，P=0．020）。与HDL—C／TC≥0．28患者比较，≤0．19患者的缺血性卒中复发率增加1．237倍（HR=2．237，95％CI：1．208-4．144，P=0．010）。结论随着HDL—C或HDL-C／TC水平的降低，缺血性卒中复发风险呈上升趋势。

Objective To observe the association between high-density lipoprotein cholesterol （HDL-C） level and rate of ischemic stroke recurrence. Methods A total of 1 059 patients with ischemic stroke were enrolled from 5 community health centers and underwent baseline surveys during the period of January 2003 to December 2006. After baseline surveys, patients were followed up every 6 months until December 3 l, 2008. The new stroke events were recorded as the primary study endpoint. The association between HDL-C, HDL-C/TC and ischemic stroke recurrence was analyzed by Cox regression analysis. Results The proportions of stroke patients with high （ 〉1 1.55 retool/L）, moderate （ 1.04 - 1.54 mmol/L） and low （ 〈 1.04 mmol/L） HDL-C levels were 15.58% （ 165/1 059） ,54. 58% （578/1 059） and 29. 84% （] 16/1 059） respectively. During a mean of （3.21 ±1.04） years follow-up, recurrent ischemic stroke was recorded in 137 patients. Compared with HDL-C t〉 1.40 mmol/L group, multivariate Cox regression analysis showed that stroke recurrence rates of patients with HDL-C ≤ 1.00 mmol/L and ranged from 1.01 to 1.19 mmol/L increased by 0. 944 （ HR = 1. 944,95% CI： 1. 033 - 3. 659, P = 0. 039 ） and 1. 027 （ HR = 2. 027, 95% CI： 1.115 - 3. 582, P = 0. 020 ） fold , respectively. Recurrence rates increased 1. 237 （ HR = 2. 237, 95% CI： 1. 208 -4. 144 ,P = 0. 010） fold in patients with HDL-C/TC 40. 19 mmol/L compared to patients with HDL-C/TC I〉 0. 28 mmol/L. Conclusion The risk of ischemic stroke recurrence increases with decreasing HDL-C level or HDL-C/TC ratio.