血浆小而密低密度脂蛋白与缺血性脑卒中的相关性

Relationship between plasma small dense low-density lipoprotein and ischemic stroke

目的探讨血浆小而密低密度脂蛋白(sd-LDL)在缺血性脑卒中中的应用价值。方法检测181例缺血性脑卒中患者(缺血性脑卒中组)和40名体检健康者(正常对照组)血浆脂蛋白各组分的水平,包括极低密度脂蛋白(VLDL)、中间密度脂蛋白(IDL)、低密度脂蛋白(LDL)及其亚组分[大而轻低密度脂蛋白(lb-LDL)、sd-LDL]和高密度脂蛋白(HDL),并计算sd-LDL/LDL比值、sd-LDL/HDL比值,同时收集患者的临床资料。采用Logistic二元回归分析评估缺血性脑卒中发生的危险因素;采用受试者工作特征(ROC)曲线评估各项指标诊断缺血性脑卒中的价值。结果缺血性脑卒中组血浆lb-LDL、sd-LDL、HDL水平及sd-LDL/LDL比值、sd-LDL/HDL比值与正常对照组比较,差异有统计学意义(P<0.05);其他项目2个组之间差异均无统计学意义(P>0.05)。Logistic二元回归单因素分析结果显示,收缩压、舒张压、三酰甘油(TG)、空腹血糖(FBG)、lb-LDL、sd-LDL、HDL、sd-LDL/LDL比值、sd-LDL/HDL比值是缺血性脑卒中发生的危险因素(P<0.05);多因素分析结果显示,仅收缩压是缺血性脑卒中发病的独立危险因素[比值比(OR)=1.065,95%可信区间(CI)为1.011~1.122]。ROC曲线分析结果显示,sd-LDL、sd-LDL/LDL和sd-LDL/HDL诊断缺血性脑卒中的曲线下面积(AUC)分别为0.675、0.741、0.762,最佳临界值分别为245 mg/L、0.225、0.342,敏感性分别为58.18%、61.72%、64.00%,特异性分别为90.00%、75.00%、70.00%。结论sd-LDL与缺血性脑卒中的发生有一定关系。sd-LDL/LDL比值和sd-LDL/HDL比值或可用于缺血性脑卒中的辅助诊断。

Objective To investigate the role of plasma small dense low-density lipoprotein(sd-LDL)in ischemic stroke.Methods The levels of plasma lipoproteins,including very low-density lipoprotein(VLDL),intermediate-density lipoprotein(IDL),low-density lipoprotein(LDL),large buoyant low-density lipoprotein(lb-LDL),sd-LDL,high-density lipoprotein(HDL),were determined in 181 patients with ischemic stroke(ischemic stroke group)and 40 healthy subjects(healthy control group).The ratio of sd-LDL/LDL and the ratio of sd-LDL/HDL were calculated.The clinical data were collected,and the risk factors of ischemic stroke were evaluated by Logistic binary regression analysis.The role of each index in the diagnosis of ischemic stroke was evaluated by receiver operating characteristic(ROC)curve.Results Compared with healthy control group,the levels of plasma lb-LDL,sd-LDL,HDL,the ratio of sd-LDL/LDL and the ratio of sd-LDL/HDL in ischemic stroke group had statistical significance(P<0.05).There was no statistical significance for the other indexes between the 2 groups(P>0.05).Logistic binary regression analysis showed that systolic blood pressure,diastolic blood pressure,triglyceride,fasting blood glucose,lb-LDL,sd-LDL,HDL,the ratio of sd-LDL/LDL and the ratio of sd-LDL/HDL were the risk factors for ischemic stroke(P<0.05).Systolic blood pressure was an independent risk factor for ischemic stroke[odds ratio(OR)=1.065,95%confidence interval(CI)1.011-1.122).ROC curve analysis showed that the areas under curves of sd-LDL,the ratio of sd-LDL/LDL and the ratio of sd-LDL/HDL were 0.675,0.741 and 0.762,respectively.The optimal cut-off values were 245 mg/L,0.225 and 0.342,respectively.The sensitivities were 58.18%,61.72%and 64.00%,and the specificities was 90.00%,75.00%and 70.00%,respectively.Conclusions Sd-LDL is related to the occurrence of ischemic stroke.The ratio of sd-LDL/LDL and the ratio of sd-LDL/HDL may be used in the diagnosis of ischemic stroke.