不同亚型的急性缺血性卒中患者血浆ox-LDL水平与预后不良的相关性

RELATIONSHIP BETWEEN SERUM OX-LDL LEVEL AND POOR PROGNOSIS IN PATIENTS WITH DIFFERENT SUBTYPES OF ACUTE ISCHEMIC STROKE

目的分析在急性缺血性脑卒中(AIS)的不同病因亚型中,血浆氧化低密度脂蛋白(ox-LDL)与预后不良的关系。方法回顾性分析我院2016年10月—2018年1月收治的480例急性缺血性脑卒中患者的临床资料,按照病因不同分型,其中大动脉粥样硬化型(LAA)292例(60.8%),小动脉闭塞型(SAO)154例(32.0%),心源性栓塞型(CE)25例(5.2%),原因不明型及其他病因型(SOE+SUE型)9例(2.0%)。依据酶联免疫吸附剂测定法检验入院时血浆ox-LDL水平,依据其四分位数水平,由低到高分为四组:Q1、Q2、Q3、Q4组。在患者入院当天用美国国立卫生研究院卒中量表评估其神经功能缺损程度,并分别在发病后第3、12个月采用改良的Rankin量表评估患者预后。用多变量回归及回归模型分别分析ox-LDL与缺血性脑卒中患者预后、各卒中病因亚型中预后不良的关系。结果480例患者平均血浆ox-LDL浓度(57.25±21.85)μg/dl。Q4组的预后不良风险最高,Q1组最低。ox-LDL水平每高10个单位,预后不良风险提高16.21%。ox-LDL水平在LAA型、SAO型中明显高于其余亚型,差异有统计学意义(P<0.01);对其余亚型的不良预后无明显作用,差异无统计学意义(均P>0.05)。结论血浆ox-LDL高水平是急性缺血性卒中的独立危险因素,尤其是LAA型、SAO型;缺血性卒中患者预后不良风险伴随着血浆ox-LDL水平升高。

Objective To analyze the relationship between plasma oxidized low-density lipoprotein(ox-LDL)and poor prognosis in patients with different subtypes of acute ischemic stroke(AIS).Methods The clinical data of four hundred and eighty patients with acute ischemic stroke treated in Affiliated Hospital of North China University of Science and Technology from October 2016 to January 2018 were retrospectively analyzed.According to different etiology,292 cases(60.8%)were large artery atherosclerosis(LAA),154(32.0%)were small artery occlusion(SAO),25 cases(5.2%)were cardiogenic embolism(CE),9 cases(2.0%)were unexplained and other etiological types(SOE+Sue).According to the level of ox-LDL at admission,the patients were divided into four groups:Q1,Q2,Q3 and Q4 according to their quartile level.On the day of admission,the NIHSS was used to assess the degree of neurological deficits,and the modified Rankin scale was used to evaluate the prognosis of the patients at 3 and 12 months after onset.Multivariate regression and regression models were used to analyze the relationship between ox-LDL and the prognosis of ischemic stroke patients,and the poor prognosis of each stroke etiology subtype.Results The mean plasma ox-LDL concentration of 480 patients was(57.25±21.85)μg/dl.The Q4 group had the highest prognostic risk and the Q1 group had the lowest.For every 10 units higher ox-LDL level,the risk of poor prognosis increased by 16.21%.The ox-LDL level was significantly higher in LAA and SAO types than that in other subtypes,the difference was statistically significant(P<0.01);it had no significant effect on the poor prognosis of the other subtypes,and the difference was not statistically significant(all P>0.05).Conclusion High plasma ox-LDL level is an independent risk factor for acute ischemic stroke,especially LAA and SAO types;the risk ofpoor prognosis in patients with AIS is accompanied by the increase of plasma ox-LDL level.