短暂性脑缺血发作患者血清小而密低密度脂蛋白胆固醇水平升高且与再发卒中风险相关的研究

The inreased level of serum small dense low-density lipoprotein cholesterol in patients with transientischemic attacks and its correlation with recurrent stroke

目的探讨短暂性脑缺血发作（TIA）患者血清小而密低密度脂蛋白胆固醇（sdLDL－C）的水平及其对TIA后再发卒中风险的评估价值。方法临床病例对照研究。收集2016年1月至12月南京总医院TIA患者96例、健康对照者44名，检测血清sdLDL－C水平；计算TIA患者ABCD3－I评分，将其分为低危（0～3分，37例）、中危（4～7分，36例）、高危（8～13分，23例）三组；同时分析TIA患者和对照者的总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平；采用Spearman相关分析和多元线性回归分析探讨TIA患者血清sdLDL－C水平与ABCD3－I评分的关联；采用Logistic回归分析血清sdLDL－C对TIA的预测评估价值。结果TIA组血清sdLDL－C水平显著高于对照组（t＝－5.202, P〈0.001）；且高危组sdLDL－C水平显著高于中危组（t＝3.534, P＝0.001）、低危组（t＝4.154, P〈0.001）。TIA患者血清sdLDL－C水平与ABCD3－I评分呈显著正相关（r＝0.317, P＝0.002）；逐步多元线性回归分析显示，在校正年龄、性别、血压及其他血脂水平的影响后，TIA患者血清sdLDL－C水平是ABCD3－I评分的唯一独立预测因子（β＝0.481，P＝0.032，校正R2＝0.189）。二元Logistic回归分析显示：在校正年龄、性别、血压及其他血脂水平的影响后，血清sdLDL－C仍与TIA的发生密切相关（OR＝2.84，95% CI＝1.42～5.70，P＝0.003）。结论TIA患者血清sdLDL－C水平升高，并与ABCD3－I评分显著独立相关。血清sdLDL－C水平有望作为TIA患者再发卒中风险评估的新指标。

Objective To investigate serum levels of small dense low-density lipoprotein cholesterol （sdLDL-C） in transient ischemic attacks （TIA） patients and assess their predictive values for subsequent stroke risk after TIA. Methods Clinical case-control study. Serum sdLDL-C levels were determined in 96 TIA patients who were admitted to Jinling Hospital fi＇om January 2016 to December 2016 and 44 healthy controls who had contemporaneously visited Jinfing Hospital For a routine or the routine. ABCD3-I scores in TIA patients were calculated. All TIA patients were classified into three subgroups： high-risk （8 ≤ ABCD3- I≤ 13, n=23）, moderate-risk （4≤ABCD3-I≤ 7, n=36） and low-risk （0≤ABCD3-I≤ 3, n=37）. Total cholesterol, triglyceride, high-density Jipoprotein cholesterol, low-density lipoprotein cholesterol and other lipid/lipoprotein parameters in TIA patients and controls were also analyzed. Spearman correlation analyses and multivariate linear regression analyses were performed to investigate the association of serum sdLDL-C levels with ABCD3-I scores. Logistic regression analyses were performed to investigate the predictive values of serum sdLDL-C for TIA patients. Results Serum sdLDL-C levels were significantly increased in TIA patients compared with controls （t = -5. 202, P 〈0. 001 ）. Furthermore, sdLDL-C levels in high-risk patients were significantly higher than that in moderate-risk （ t = 3. 534, P = 0. 001 ） and low- risk （ t = 4. 154, P 〈 0. 001 ） patients. Serum sdLDL-C levels were positively correlated with ABCD3-I scores（ r = 0. 317, P = 0. 002 ） in TIA patients. The stepwise multiple regression analysis showed that only sdLDL- C was a significant independent predictor of ABCD3-I scores （β = 0.481, P = 0. 032, adjusted R2 = 0. 189 ） , after adjusting for age, gender, blood pressure and other lipid/lipoprotein parameters. Binary Logistic analyses indicated that serum sdLDL-C levels were closely associated with TIA presence （OR = 2. 84, 95% CI = 1.42 - 5.70, P = 0. 003 ） , after adjustment with age, gender, blood pressure and other lipid/ lipoprotein parameters. Conclusions Serum sdLDL-C levels were increased in TIA patients. The significantly independent associations of sdLDL-C levels with ABCD3-I scores were observed. Serum sdLDL-C levels may contribute to assessing subsequent stroke risk after TIA.