不同性别老年脑出血患者血脂水平与预后的关系研究

Gender Difference Analysis of the Relationship between Serum Lipids Levels and Prognosis in Elderly Patients with Intracerebral Hemorrhage

目的探讨血脂水平与不同性别老年脑出血患者90 d临床预后的关系。方法本研究数据来源于多中心、前瞻性、观察性队列登记研究--北京地区以病因为基础的脑出血医疗质量评价与微创手术治疗技术研究(登记号:2011-2004-03),从数据库中筛选2014年12月-2016年9月连续纳入的经头颅CT确诊为急性期脑出血患者的临床资料进行回顾性分析。收集患者的性别、年龄、NIHSS评分、GCS评分、血肿体积、出血部位等临床资料,以及白细胞和血小板计数、血脂水平等实验室检查资料。以90 d mRS>2分定义为预后不良,分别比较男性和女性不同预后患者血脂水平的差异,并应用logistic回归分析血脂水平对不同性别患者发病90 d预后的影响。结果本研究最终纳入212例脑出血患者,平均年龄73.4±6.5岁,男性126例(59.4%),女性86例(40.6%)。单因素分析结果显示,在男性患者中,预后不良组年龄(P=0.038)、入院时NIHSS评分(P<0.001)、空腹血糖(P=0.014)、HDL-C水平(P=0.010)、血肿体积(P=0.003)及出血破入脑室患者比例(P=0.015)高于预后良好组,入院时GCS评分(P<0.001)低于预后良好组;在女性患者中,预后不良组年龄(P=0.031)、入院时NIHSS评分(P<0.001)及血肿体积(P=0.023)高于预后良好组,入院时GCS评分(P<0.001)、TG(P=0.016)及非高密度脂蛋白胆固醇(non-high density lipoprotein cholesterol,non-HDL-C)水平(P=0.020)低于预后良好组。logistic回归分析结果显示,对于男性患者,高龄(OR 1.119,95%CI 1.027~1.219,P=0.010)、入院时高NIHSS评分(OR 1.373,95%CI 1.188~1.586,P<0.001)和出血破入脑室(OR 3.471,95%CI 1.112~10.832,P=0.032)是90 d预后的独立危险因素;对于女性患者,入院时高NIHSS评分(OR 1.254,95%CI 1.078~1.459,P=0.003)是90 d预后的独立危险因素,高水平的non-HDL-C是90 d预后的保护性因素(OR 0.978,95%CI 0.961~0.996,P=0.014)。结论血脂水平对老年脑出血患者的临床预后预测价值存在性别差异。高水平的non-HDL-C是老年女性脑出血患者90 d预后的保护性因素。

Objective To investigate the relationship between serum lipids levels and 90-day clinical prognosis of elderly intracerebral hemorrhage patients of different genders.Methods This retrospective study enrolled elderly patients with acute intracerebral hemorrhage diagnosed by CT between December 2014 and September 2016 from a multicenter,prospective and observational cohort registration study(registration number:2011-2004-03).The collected data included demographic information,NIHSS and GCS at admission,and laboratory tests results,etc.The poor prognosis was defined as a 90-day mRS score>2.The differences in serum lipids levels between different prognosis groups in male and female patients were compared.Multivariate logistic regression analysis was used to analyze the relationship of serum lipids levels and 90-day functional prognosis of patients of different genders.Results Finally this study included 212 eligible patients with cerebral hemorrhage,with an average age of 73.4±6.5 years old,126 males(59.4%)and 86 females(40.6%).Univariate analysis showed that for male patients,the age(P=0.038),baseline NIHSS score(P<0.001),fasting blood glucose(P=0.014),HDL-C level(P=0.010),hematoma volume(P=0.003)and the proportion of patients with bleeding into the ventricle(P=0.015)in poor prognosis group were all higher than those in good prognosis group,and the baseline GCS score(P<0.001)was lower than that in good prognosis group;for female patients,the age(P=0.031),baseline NIHSS score(P<0.001)and hematoma volume(P=0.023)in poor prognosis group were all higher than those in good prognosis group,and the baseline GCS score(P<0.001),TG(P=0.016)and non-HDL-C levels(P=0.020)were lower than those in good prognosis group.Multivariate logistic regression analysis showed that for male patients,advanced age(OR 1.119,95%CI 1.027-1.219,P=0.010),high baseline NIHSS score(OR 1.373,95%CI 1.188-1.586,P<0.001)and bleeding into the ventricle(OR 3.471,95%CI 1.112-10.832,P=0.032)were independent risk factors for 90-day clinical prognosis;for female patients,high baseline NIHSS score(OR 1.254,95%CI 1.078-1.459,P=0.003)was an independent risk factor for 90-day clinical prognosis,and high non-HDL-C level was a protective factor for 90-day clinical prognosis(OR 0.978,95%CI 0.961-0.996,P=0.014).Conclusions There were gender differences in the predictive value of serum lipids for clinical prognosis of elderly patients with intracerebral hemorrhage.High non-HDL-C level was a protective factor for 90-day prognosis of elderly with intracerebral hemorrhage.