脑出血转化与总胆固醇、低密度脂蛋白及高密度脂蛋白的相关性

Correlations between cerebral hemorrhage transformation and total cholesterol,low density lipoprotein and high density lipoprotein

目的探讨脑出血转化与总胆固醇、低密度脂蛋白及高密度脂蛋白的相关性。方法选取急性脑梗死患者286例作为脑梗死组,选取健康体检中老年人156例作为对照组。急性脑梗死患者于入院1周后行头颅MRI或CE检查。根据是否合并脑出血转化将患者分为转化组与非转化组,行脑出血转化相关因素的Logistic多变量回归分析,分析脑出血转化与血脂的相关性。结果脑梗死组LDL-C为(2.01±0.45)mmol/L,显著低于对照组的(3.52±0.83)mmol/L(P<0.05)。256例急性脑梗死患者中,脑出血转化31例,其糖尿病、心房纤颤及尿激酶溶栓的比例相对较高,脑白质疏松发生率、TC、LDL-C、HDL-C则相对较低,与非转化组相比有显著差异(P<0.05)。Logistic回归分析显示,脑梗死患者脑出血转化的保护因素为低密度脂蛋白。结论急性脑梗死患者入院时低水平低密度脂蛋白与脑出血转化相关,对于低水平低密度脂蛋白、心源性脑栓塞及高NIHSS评分患者,应谨慎强化降脂治疗,防止脑出血转化发生。

Objective To explore the correlations between cerebral hemorrhage transformation and total cholesterol,low density lipoprotein（ LDL） and high density lipoprotein（ HDL）. Methods A total of 286 patients with acute cerebral infarction were selected as cerebral infarction group,and 156 elderly people with health examination were selected as control group. Patients in cerebral infarction group were conducted with cranial MRI or CE examination 1 week after hospital admission.According to the result of cerebral hemorrhage transformation,patients in cerebral infarction group were divided into transform group and non-transform group. Correlation between cerebral hemorrhage transformation and lipids were analyzed. Results Level of LDL-C in cerebral infarction group was（ 2. 01 ± 0. 45） mmol/L,which was significantly lower than（ 3. 52 ± 0. 83） mmol/L in the control group（ P〈0. 05）. Among 256 patients with acute cerebral infarction,31 patients had hemorrhagic transformation,and the ratios of diabetes,arterial fibrillation and urokinase thrombolysis were relatively high,while incidence rate of leukoaraiosis,TC,LDL-C and HDL-C were relatively low,and there were significant differences when compared with the non-transform group（ P〈0. 05）. The Logistic regression analysis showed that protective factor for cerebral infarction patients with cerebral hemorrhage transformation was LDL. Conclusion The low level of LDL in patients with acute cerebral infarction is correlated with cerebral hemorrhage transformation. For patients with low level of LDL,cardiogenic cerebral embolism and high NIHSS score,the intensive lipid-lowering treatment should be performed carefully to prevent the occurrence of cerebral hemorrhage transformation.