国内缺血性卒中患者家族性高胆固醇血症检出率及临床特征研究

Prevalence and Clinical Characteristics of Familial Hypercholesterolemia among Chinese Middle-aged Patients with Ischemic Stroke

目的分析我国成人缺血性卒中患者家族性高胆固醇血症(FH)的检出率及临床特征。方法纳入"心血管病高危人群早期筛查与综合干预项目"2015年9月至2020年8月收集的缺血性卒中患者,根据《中国家族性高胆固醇血症筛查及治疗专家共识》中FH诊断标准、筛查FH检出率,描述我国缺血性卒中合并FH患者的临床特征,以及降脂药物的使用情况,比较缺血性卒中患者中不同亚组间FH检出率的差异。结果研究共纳入35~75岁缺血性卒中患者18147例,平均年龄为(62.3±7.7)岁,男性8609例(47.44%),城市患者7437例(40.98%)。在所有缺血性卒中患者中,检出FH患者63例,检出率为0.35%(1/286)。女性缺血性卒中患者中FH检出率约为男性缺血性卒中患者的3倍(0.50%∶0.17%,P<0.001)。东部、中部及西部地区缺血性卒中患者FH检出率分别为0.52%、0.21%以及0.34%(P<0.01)。城市缺血性卒中FH检出率高于农村缺血性卒中患者(0.50%∶0.24%,P<0.01)。FH患者中早发冠心病及早发卒中比例显著高于非FH患者(6.35%∶2.22%,71.78%∶57.50%,P<0.05)。FH患者接受降脂药物和他汀比例显著高于非FH组患者(42.86%∶17.31%,36.51%∶9.83%,P<0.001),但无1例达到指南推荐的LDL-C水平。结论在我国,每286例成年缺血性卒中患者中就有1例FH,LDL-C达标率低。提示对缺血性卒中患者,应尽早识别FH患者,从而采用强化降脂治疗,提高LDL-C达标率。

Objective To analyze the prevalence and clinical characteristics of familial hypercholesterolemia(FH)in Chinese patients with ischemic stroke.Methods From September 2015 to August 2020,middle-aged patients with ischemic stroke were enrolled from the Program of Screening and Intervention Subjects with High Risk Cardiovascular Disease.Based on Chinese expert consensus on screening diagnosis and treatment of familial hypercholesterolemia,the prevalence of FH,clinical characteristics and the use of lipid-lowering medication among Chinese middle-aged patients with ischemic stroke were presented.FH prevalence of varied subgroups were compared.Results A total of 18147 patients with ischemic stroke aged from 35 to 75 years old were enrolled in our study.Among the patients,mean age was(62.25±7.66)years,8609(47.44%)were male and 7437(40.98%)live in urban area.The overall FH prevalence was 0.35%or 1 in 286.FH prevalence in female were 3 times higher than male(0.50%vs.0.17%,P<0.001).FH prevalence of eastern,central and western China were 0.52%,0.21%and 0.34%,respectively.Patients with ischemic stroke living in rural have lower prevalence compared with urban patients(0.24%vs.0.50%).Incidence of premature coronary artery disease(CAD)and premature ischemic stroke in FH patients were significantly higher than in non-FH patients(6.35%vs.2.22%and 77.78%vs.57.50%,P<0.05).Rate of FH patients receiving lipid-lowering medication and statins treatment were significantly higher than non-FH patients(42.86%vs.17.31%,36.51%vs.9.83%,P<0.001),but none of the FH patients achieved guideline recommended LDL-C targets.Conclusion FH affected 1 in 286 Chinese middle-aged patients with ischemic stroke and the achievement of LDL-C target was low,suggesting early identification,intensive lipid-lowering treatment are definitely needed for achieving the LDL-C target.