甘油三酯／高密度脂蛋白胆固醇的比值在急性缺血性脑卒中预后价值的研究

Triglyceride to high -density lipoprotein cholesterol ratio predicts worse outcomes after acute ischemie stroke

目的探讨甘油三酯（TG）／高密度脂蛋白胆固醇（HDL-C）比值与急性缺血性脑卒中（AIS）患者预后的关系。方法收集1006例首发AIS住院患者的临床资料。所有患者在入院36h内分别测定血浆TG、总胆固醇（TC）、HDL-C和低密度脂蛋白胆固醇（LDL-C）的水平。3个月后根据改良Rankin评分量表（mRS）分为两种不同的预后：mRS 0-1预后良好，6即死亡。结果较高水平TG、非高密度脂蛋白胆固醇（Non-HDL-C）和TG／HDL-C与AIS患者预后密切相关：预后良好的OR值分别为1．39、1．89和2．34，死亡的OR值分别为0．59、0．29和0．26。TG／HDL-C≥0．87是临床预后良好[ROC曲线下面积（AUC）为0．596，敏感度73．3％，特异度42．7％]和非死亡（AUC0．674，敏感度67．8％，特异度60．6％）的最佳区分因子。与TG／HDL-C／〉0．87比较，TG／HDL-C〈0．87时AIS患者死亡风险增加2．94倍。结论较低的TG／HDL-C比值与AIS患者3个月后死亡和预后不良独立相关。

Objective The effect of triglyceride （TG）to high -density lipoprotein cholesterol （ HDL - C） ratio （ TG/HDL - C） on clinical outcomes of acute isehemic stroke （AIS） patients is unclear. This study sought to determine whether the TG/HDL- C in AIS patients is associated with worse outcomes. Methods AIS patients were enrolled in this study. TG, total cholesterol（TC）, HDL - C, and low - density lipoprotein cholesterol （ LDL - C ） were collected on admission. We defined 2 endpoints according to the modified Rankin scale （mRS） score at 3 months after symptom onset （ excellent outcome, mRS 0 - 1 and death, mRS 6）. Results Higher TG, non - HDL - C and TG/HDL - C were strongly associated with the 2 endpoints after adjustments ： excellent [ odds ratio （OR） = 1.39, OR = 1.89 and OR = 2.34, respectively）and death（ OR = 0.59, OR=0.29 and OR = 0.26 ）]. According to the receiver operator characteristic （ ROC ） analysis, the best discriminating factor was a TG/HDL - C ≥ 0. 87 for excellent outcomes[ area under the ROC curve（ AUC）0.596, sensitivity 73.3%, specificity 42.7% ] and non - death（AUC 0. 674, sensitivity 67.8%, specificity 60. 6% ）. Patients with a TG/HDL - C 〈0. 87 had a 2.94 - fold increased risk of death compared with patients with a TG/HDL - C ≥0.87. Conclusion A lower TG/HDL - C is independently associated with death and worse outcome at 3 months in AIS.