胆红素血脂综合指数与急性脑梗死患者颈动脉易损斑块的相关性研究

Correlation between bilirubin lipid complex index and vulnerable carotid plaque in patients with acute cerebral infarction

目的研究胆红素血脂综合指数与急性脑梗死(ACI)患者颈动脉易损斑块的相关性。方法选取2021年11月至2022年11月于锦州医科大学附属第三医院神经内科住院的300例ACI患者,根据颈部血管超声结果将其分为内膜正常组52例、内膜增厚组68例和斑块组180例;将斑块组分为稳定斑块组73例和易损斑块组107例。检测血清总胆红素(TBIL)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等生化指标。计算胆红素血脂综合指数1[TC/(HDL-C+TBIL)]、胆红素血脂综合指数2[LDL-C/(HDL-C+TBIL)]。比较内膜正常组、内膜增厚组和斑块组间的一般临床资料和各项指标;稳定斑块组和易损斑块组间的一般临床资料和各项指标进行比较;采用二元Logistic回归分析确定ACI患者颈动脉易损斑块的独立危险因素,采用ROC曲线分析胆红素血脂综合指数对ACI患者颈动脉易损斑块的预测价值。结果斑块组胆红素血脂综合指数1、指数2均高于内膜正常组和内膜增厚组,差异具有统计学意义(P<0.05);易损斑块组胆红素血脂综合指数1、指数2高于稳定斑块组,差异有统计学意义(P<0.05);胆红素血脂综合指数1、指数2可作为ACI患者颈动脉易损斑块的独立危险因素;ROC曲线显示:胆红素血脂综合指数1曲线下面积(AUC)为0.704(95%CI:0.624~0.784,P=0.000)、敏感度分别为0.748,特异度为0.603。胆红素血脂综合指数2曲线下面积(AUC)为0.715(95%CI:0.641~0.790,P=0.000),敏感度为0.748,特异度为0.616。结论胆红素血脂综合指数与ACI患者颈动脉内膜增厚程度呈正相关;胆红素血脂综合指数是ACI患者颈动脉易损斑块的独立危险因素;胆红素血脂综合指数对ACI患者颈动脉易损斑块的形成具有一定的预测价值。

【Objective】To explore the correlation between bilirubin lipid complex index and vulnerable carotid plaque in patients with acute cerebral infarction(ACI).【Methods】From November 2021 to November 2022,300 ACI patients treated in the Department of Neurology of the Third Affiliated Hospital of Jinzhou Medical University were selected.According to the results of cervical vascular ultrasound,300 ACI patients were divided into normal intima group(52 cases),thickened intima group(68 cases)and plaque group(180 cases).The plaque group was divided into stable plaque group(73 cases)and vulnerable plaque group(107 cases).Serum total bilirubin(TBIL),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)and other biochemical indicators were detected.Bilirubin lipid composite index 1[TC/(HDL-C+TBIL)],bilirubin lipid composite index 2[LDL-C/(HDL-C+TBIL)]were calculated.The general clinical data and various indicators among the normal intima group,thickened intima group and plaque group were compared.The general clinical data and various indicators between stable plaque group and vulnerable plaque group were compared.Logistic regression analysis was used to analyze the independent risk factors of carotid vulnerable plaque in ACI patients,and the ROC curve was used to assess the predictive value of bilirubin lipid composite index for carotid vulnerable plaque in ACI patients.【Results】The bilirubin lipid composite index 1 and index 2 in plaque group were significantly higher than those in normal intima group and intimal thickening group(P<0.05).The bilirubin lipid composite index 1 and index 2 in vulnerable plaque group were higher than those in stable plaque group(P<0.05).The bilirubin lipid composite index 1 and index 2 can be used as independent risk factors for carotid vulnerable plaque in ACI patients.ROC curve showed that the area under the curve(AUC)of bilirubin lipid composite index 1 was 0.704(95%CI:0.624 to 0.784,P=0.000),the sensitivity was 0.748,and the specificity was 0.603.The area under the curve(AUC)of bilirubin lipid composite index 2 was 0.715(95%CI:0.641 to 0.790,P=0.000),the sensitivity was 0.748,and the specificity was 0.616.【Conclusion】Bilirubin lipid composite index is positively correlated with carotid intima thickening in ACI patients.Bilirubin lipid complex index is an independent risk factor for carotid vulnerable plaque in patients with ACI.Bilirubin lipid composite index has a certain predictive value for the formation of vulnerable carotid plaque in ACI patients.