非高密度与残粒脂蛋白胆固醇对青年家族聚集性急性脑卒中预后的预测评价

The value of non-HDL cholesterol and remnant cholesterol in predicting the prognosis of young familial onset acute stroke

目的探讨非高密度脂蛋白胆固醇与残粒胆脂蛋白固醇对青年家族聚集性急性脑卒中患者发生不良脑血管事件及预后的预测评价。方法对142例青年家族聚集性急性脑卒中患者出院后进行为期18个月的随访;根据患者是否发生不良脑血管事件分为脑血管不良事件组和非脑血管不良事件组,比较2组总胆固醇、非高密度胆固醇、残粒脂蛋白胆固醇和载脂蛋白B的表达水平与发生血管不良事件的相关性。结果随访期间出现不良脑血管事件46例(32.4%),其中出现混合型高脂血症者29例(63.0%),非脑血管不良事件组出现18例(18.7%),2组比较差异有统计学意义(P<0.01);脑血管不良事件组血清总胆固醇、非高密度胆固醇、残粒脂蛋白胆固醇、甘油三酯、载脂蛋白B水平均显著高于非脑血管不良事件组(P<0.05或0.01);单因素分析显示,总胆固醇、残粒脂蛋白胆固醇、非高密度脂蛋白胆固醇、载脂蛋白B、甘油三酯是青年家族聚集性急性脑卒中患者发生脑血管不良事件的危险因素;多因素分析显示,总胆固醇、残粒脂蛋白及非高密度脂蛋白胆固醇是青年家族聚集性急性脑卒中患者发生脑血管不良事件的危险因素。结论非高密度脂蛋白胆固醇与残粒脂蛋白胆固醇水平升高的青年家族聚集性急性脑卒中患者预后较差,非高密度脂蛋白胆固醇与残粒脂蛋白胆固醇是青年家族聚集性急性脑卒中的始动因素,可作为主要不良脑血管事件的预测指标。

Objective To investigate the predictive value of non-HDL cholesterol and remnant cholesterol in predicting the prognosis of younger familial onset acute stroke.Methods 142 patients with young familial onset acute stroke were followed up for 18 months after discharge.Patients were divided into MACE group and non-MACE group according to whether MACE occurred.The correlation between the expression levels of total cholesterol,non-HDL,remnant cholesterol,Apo B and vascular adverse events was compared between the two groups.Results During the 18 month follow-up period,there were 46 cases of adverse cardiovascular events in 142 patients(32.4%).29 cases(63.0%)of familial mixed hyperlipidemia in the MACE group,18 cases(18.7%)in the non-MACE group,and the difference between the two groups was statistically significant(P<0.01).The serum total cholesterol,non-HDL,remnant cholesterol,triglyceride,and Apo B levels in the MACE group were significantly higher than those in the non-MACE group(P<0.05 or 0.01).Univariate analysis of MACE incidence showed that total cholesterol,remnant cholesterol,non-HDL,Apo B,and triglyceride were risk factors for cerebrovascular adverse events in patients with early onset acute myocardial infarction.Multivariate analysis of the incidence of MACE showed that total cholesterol,remnant cholesterol,and non-HDL were risk factors for cerebrovascular adverse events in patients with younger adults familial onset acute stroke.Conclusion Patients with young familial onset acute stroke with elevated non-HDL and remnant cholesterol levels have a poor prognosis.Non-HDL and remnant cholesterol are the initiating factors of young familial onset acute stroke and can predict the prognostic outcome of major cerebrovascular events.