膳食多不饱和脂肪酸摄入对急性缺血性卒中或短暂性脑缺血发作患者血清脂蛋白、C反应蛋白及高半胱氨酸的影响

Effects of dietary polyunsaturated fatty acid intake on serum lipoprotein,C-reactive protein and homocysteine in patients with acute ischemic stroke or transient ischemic attack

目的探讨膳食多不饱和脂肪酸(polyunsaturated fatty acid,PUFA)摄入量与急性缺血性卒中或短暂性脑缺血发作(transient ischemic attack,TIA)患者血脂、C反应蛋白(C-reactive protein,CRP)及高半胱氨酸(homocysteine,Hcy)之间的关系。方法从南京卒中注册系统中连续入组急性缺血性卒中或TIA患者。采用食物半定量频率调查问卷评估膳食总PUFA摄入水平。在患者入院次日清晨采集静脉血样,检测血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、Hcy和CRP水平。按照总PUFA摄入量的中位数水平,将患者分为低PUFA组和高PUPA组。对PUFA摄入量与血脂、CRP和Hcy之间的关系进行Spearman相关分析,然后应用多元线性回归分析确定独立相关性。结果共纳入急性缺血性卒中患者171例(85.1%),TIA患者30例(14.9%)。患者年龄为(62.9±14.1)岁,男性143例(71.1%),中位PUFA日摄入量为12.80 g(四分位数间距:8.05~17.50 g)。与高PUFA组(100例)相比,低PUFA组(101例)的患者年龄更大,血清高密度脂蛋白胆固醇水平更低,而CRP和Hcy水平更高,上述差异均具有统计学意义(P均<0.05)。Spearman相关分析显示,膳食总PUFA摄入量与血清CRP(r=-0.24,P=0.001)和Hcy(r=-0.17,P=0.013)水平均呈显著负相关,而与血脂水平无显著相关性。多元线性回归分析显示,校正混杂因素后,CRP与PUFA摄入量呈显著负相关(B=-0.28,P=0.012)。结论急性缺血性卒中或TIA患者膳食PUFA摄入量可能会影响血液代谢指标和氧化应激指标,PUFA摄入量偏低的患者有必要适当调整膳食结构以降低卒中复发风险。

Objective To investigate the relationship between dietary polyunsaturated fatty acid(PUFA)intake and blood lipid,C-reactive protein(CRP)and homocysteine(Hcy)in patients with acute ischemic stroke or transient ischemic attack(TIA).Methods Patients with acute ischemic stroke or TIA were enrolled consecutively from Nanjing Stroke Registry Program.The total dietary PUFA intake level was assessed by the food semi-quantitative frequency questionnaire.Venous blood samples were collected in the morning of the day after admission to the hospital to detect the levels of serum total cholesterol,triacylglycerol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,Hcy,and CRP.According to the median level of total PUFA intake,the patients were divided into low PUFA group and high PUFA group.The relationship between PUFA intake and blood lipid,CRP and Hcy was analyzed by Spearman correlation analysis,and multiple linear regression analysis was used to determine the independent correlation.Results A total of 170 patients(85.1%)with acute ischemic stroke and 31 patients with TIA(14.9%)were enrolled.Their age was 62.9±14.1 years,143 were males(71.1%),and the median PUFA daily intake was 12.8 g(interquartile range:8.05-17.5 g).Compared with the high PUFA group(n=100),patients in the low PUFA group(n=101)were older,serum high-density lipoprotein cholesterol levels were lower,and CRP and Hcy levels were higher.The above differences were statistically significant(all P<0.05).Spearman correlation analysis showed that total dietary PUFA intake was significantly negatively correlated with the serum CRP(r=-0.24,P=0.001)and Hcy(r=-0.17,P=0.013)levels,and there was no significant correlation with the blood lipid levels.Multiple linear regression analysis showed that CRP was significantly negatively correlated with PUFA intake after adjusting for confounding factors(B=-0.28,P=0.012).Conclusions Dietary PUFA intake in patients with acute ischemic stroke or TIA may affect blood metabolism index and oxidative stress index.It is necessary to adjust the dietary structure of patients with low PUFA intake to reduce the risk of stroke recurrence.