青年急性脑梗死患者血脂紊乱与颈动脉内膜中层厚度的关系及其危险因素分析

Relationship between dyslipidemia and carotid artery intima-media thickness in young patients with acute cerebral infarction and analysis of risk factors

目的分析青年脑梗死患者血脂谱特征与颈动脉内膜中层厚度（cIMT）的关系以及危险因素。方法选择2011年12月至2015年3月河南省人民医院急诊医学部住院的630例急性脑梗死患者，纳入其中126例年龄17～45岁的青年急性脑梗死患者作为研究组，选择同期本院门诊体检的60例青年自愿者作为健康对照组。记录两组患者的性别、年龄、体质量指数（BMI）、高血压病史、糖尿病史、吸烟史、饮酒史、血脂水平，以及用超声测量的cIMT值，采用Pearson相关分析法分析cIMT与载脂蛋白B／载脂蛋白A—I（ApoB／ApoA—I）的相关性，多因素Logistic回归分析影响青年脑梗死的危险因素。结果单因素分析显示，研究组青年脑梗死患者伴高血压病史比例[42．1％（53／126）比15．O％（9／60）]、总胆固醇[TC（mmol／L）：5．23±1．07比4．75±0．65]、ApoB【g／L：1．20±0．26比1．04±0．27）、ApoB／ApoA—I比值（0．87±0．25比0．71±0．22）、cIMT（mm：1．20±0．22比1．08±0．14）均较对照组明显升高（均P〈0．05），是影响青年急性脑梗死发病的危险因素；Pearson相关分析显示ApoB／ApoA—I与cIMT呈显著正相关关系（r=0．281，P〈0．05）；将两组有统计学意义的指标高血压病史、TC、ApoB、ApoB／ApoA—I比值、cIMT进行多因素logistic回归分析结果显示，高血压病史（优势比（OR）=1．956，95％可信区间（95％CI）=1．026～3．274，P=0．045]、ApoB（OR=3．357，95％CI=1．232—7．764，P=0．019）、ApoB／ApoA—I（OR=6．163，95％CI=1．518—2．417，P=0．000）、eIMT（OR=4．251，95％CI=1．276—12．942，P=0．010）是青年急性脑梗死的危险因素，其中ApoB／ApoA—I比值是独立危险因素。结论青年脑梗死患者血脂异常以TC、ApoB、ApoB／ApoA—I的变化为主，且ApoB／ApoA—I与cIMT呈显著的正相关关系；ApoB／ApoA—I是影响青年急性脑梗死的独立危险因素。

Objective To analyze the relationship between blood lipid features and carotid artery intima-media thickness （cIMT） in young patients with acute cerebral infarction and the risk factors in such patients. Methods 630 young patients with acute cerebral infarction admitted to the Department of Emergency in Henan Provincial People＇s Hospital from December 2011 to March 2015 were enrolled, there were 126 cases aged between 17 and 45 years old being in research group, and 60 young volunteers having taken physical health examination in the same period in outpatient clinics of this hospital were assigned in the healthy control group. The gender, age, body mass index （BMI）, hypertension history, diabetes mellitus history, smokeing, alcohol intake, blood lipid were reeroded in the two groups the uhrasonie measurement for cIMT were performed in the two groups. The correlation between eIMT and apolipoprotein B/apolipoprotein A-I （ApoA/ApoB -I ） was analyzed by Pearson correlation analysis. Multiple factors Logistic regression method was used to analyze the risk factors of patients with youth cerebral infarction. Results The univariate analysis showed： hypertension history proportion in such patients [42.1% （53/126） vs. 15.0% （9/60）], total cholesterol [TC （mmol/L）： 5.23 ± 1.07 vs. 4.75 ± 0.65], ApoB （AL ： 1.20 ± 0.26 vs. 1.04 ± 0.27）, ApoB/apoA- I ratio （0.87 ± 0.25 vs. 0.71 ± 0.22） and eIMT （mm： 1.20 ±0.22 vs. 1.08 ± 0.14） in the research group were significantly higher than those in the control group （all P 〈 0.05）, which were risk factors for occurrences of young patients with aetue cerebral infarction. The Pearson correlation analysis showed that ApoB/ApoA-I was positively significantly correlated to cIMT （r = 0.281, P 〈 0.05）. The statistically significant indicators between two groups such as hypertension history, TC, ApoB, ApoB/ApoA- I ratio and cIMT were analyzed by univariate analysis, and the findings showed that the history of hypertension, TC, ApoB, ApoB/ApoA-I ratio and cIMT were the risk factors in youth patients with acute cerebral infarction. Multivariate regression analysis showed that hypertension history [odds ratio （OR） = 1.956, 95% confidence interval （95%C/） = 1.026 - 3.274, P = 0.045], ApoB （OR = 3.357, 95%CI = 1.232 - 7.764,P = 0.019）, ApoB/apoA-I （OR = 6.163, 95%CI = 1.518 - 2.417, P = 0.000） and cIMT （OR = 4.251,95%CI = 1.276 - 12.942, P = 0.010） were risk factors of acute cerebral infarction in young patients, the ApoB/ApoA- I was the independent risk factors of acute cerebral infarction in young patients. Conclusions The changes of blood lipids in patients with youth acute cerebral infarction are mainly TC, ApoB and ApoB/ApoA-I and ApoB/ApoA-I is significantly positively correlated to the cIMT, therefore ApoB/ApoA-I is the most significant independent risk factor associated with acute cerebral infarction in young patients.