血脂指标及其比值与脑白质高信号关系的临床研究

Clinical Study on the Relationship Between Blood Lipid Index and Its Ratio and White Matter Hyperintensity

目的探讨血脂指标及其比值与脑白质高信号(white matter hyperintensities,WMHs)之间的相关性及其临床意义。方法选取2022年1月1日至2022年12月31日于阜新市第二人民医院(阜新市妇产医院)神经内科就诊的无症状腔隙性脑梗死的患者,根据头颅磁共振的T2WI和FLAIR序列是否有高信号分为研究组(WMHs组)和对照组(非WMHs组),WMHs的诊断符合《中国脑小血管病诊治专家共识2021》诊断标准。收集两组患者的年龄、吸烟饮酒和高血压病史等一般资料,以及总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、脂蛋白a(liproteins(a),Lp(a))、载脂蛋白A1(apolipoproteinA1,ApoA1)和载脂蛋白B(apolipoproteinB,ApoB)及同型半胱氨酸(homocysteine,Hcy)和尿酸(uric acid,UA)等检测结果,计算TC/HDL-C、TG/HDL-C、LDL-C/HDL-C和ApoB/ApoA1比值。通过Logistic回归分析和ROC曲线分析评价血脂指标及其比值在WMHs发生中的作用。结果(1)研究组入组患者97例,平均年龄(66.52±6.67)岁,男性50例、女性47例;对照组入组患者80例,平均年龄(65.26±8.72)岁,男性44例、女性36例。两组患者在年龄、吸烟饮酒情况、高血压和糖尿病等方面差异有统计学意义(P<0.05);而在性别、冠心病、心房颤动、Hcy和UA间的差异无统计学意义(P>0.05);(2)与对照组相比,研究组患者的血清LDL-C、ApoB、TC/HDL-C、TG/HDL-C、LDL-C/HDL-C和ApoB/ApoA1显著升高(P<0.05);而HDL-C和ApoA1明显降低(P<0.05)。多因素回归分析结果显示年龄、TC/HDL-C、LDL-C/HDL-C和ApoB/ApoA1可能是WMHs发生的独立危险因素(P<0.05);Spearman相关性分析发现TC/HDL-C、LDL-c/HDL-c和ApoB/ApoA1与WMHs的病情严重程度呈正相关。(3)ROC曲线分析发现TC/HDL-C预测WMHs发生的AUC为0.639(P<0.05,95%CI:0.524~0.755),截取值取5.145时,敏感度为61.9%、特异性为76.2%;TG/HDL-C预测WMHs发生的AUC为0.403(P>0.05,95%CI:0.289~0.516),截取值取2.575时,敏感度为13.5%、特异性为30%;LDL-C/HDL-C预测WMHs发生的AUC为0.831(P<0.05,95%CI:0.754~0.917),截取值取3.54时,敏感度为64.9%、特异性为85%;ApoB/ApoA1预测WMHs发生的AUC为0.740(P<0.05,95%CI:0.630~0.850),截取值取0.945时,敏感度为52.6%、特异性为92.5%。结论年龄、TC/HDL-C、LDL-C/HDL-C和ApoB/ApoA1参与了WMHs的发病过程,可能是其发生的独立危险因素;TC/HDL-C、LDL-C/HDL-C和ApoB/ApoA1与WMHs患者的病情严重程度呈正相关,其中LDL-C/HDL-C和ApoB/ApoA1对WMHs的发生可能有预测作用。

Objective To explore the correlation and clinical significance between blood lipid indicators and their ratios and white matter hyperintensities(WMHs)in the brain.Methods Patients with asymptomatic lacunal cerebral infarction who were admitted to the Department of Neurology of Fuxin Second People′s Hospital(Fuxin Obstetrics and Gynecology Hospital)from January 1,2022 to December 31,2022 were selected and divided into study group(WMHs group)and control group(non-WMHs group)according to whether T2WI and FLAIR sequences of cranial magnetic resonance showed high signal.The diagnosis of WMHs was in line with the diagnostic criteria of“China Expert Consensus on Diagnosis and Treatment of Small Cerebral Vascular Diseases 2021”.General data such as age,smoking and alcohol consumption,and history of hypertension as well as the test results such as total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),lipoprotein a,Lp(a),apolipoprotein AI(ApoA1),apolipoprotein B(ApoB),homocysteine(Hcy)and uric acid(UA)were collected.The ratios of TC/HDL-C,TG/HDL-C,LDL-C/HDL-C and ApoB/ApoA1 were calculated.The role of lipid index and its ratio in the occurrence of WMHs was evaluated by Logistic regression analysis and ROC curve analysis.Results(1)The study group included 97 patients with an average age of(66.52±6.67)years,including 50 males and 47 females.The control group included 80 patients,with an average age of(65.26±8.72)years,44 males and 36 females.There were statistically significant differences in age,smoking and drinking status,hypertension and diabetes between the two groups(P<0.05);there was no significant difference in sex,coronary heart disease,atrial fibrillation,Hcy and UA(P>0.05).(2)compared with control group,serum LDL-C,ApoB,TC/HDL-C,TG/HDL-C,LDL-C/HDL-C and ApoB/ApoA1 in study group were significantly increased(P<0.05);HDL-C and ApoA1 were significantly decreased(P<0.05);multivariate regression analysis showed that age,TC/HDL-C,LDL-C/HDL-C and ApoB/ApoA1 may be independent risk factors for WMHs(P<0.05);Spearman correlation analysis found that TC/HDL-C,LDL-c/HDL-c and ApoB/ApoA1 were positively correlated with the severity of WMHs.(3)ROC curve analysis showed that the AUC of TC/HDL-C predicting the occurrence of WMHs was 0.639(P<0.05,95%CI:0.524~0.755),and when the interception value was 5.145,the sensitivity was 61.9%and the specificity was 76.2%.The AUC of TG/HDL-C for predicting the occurrence of WMHs was 0.403(P>0.05,95%CI:0.289~0.516),and the sensitivity and specificity were 13.5%and 30%when the interception value was 2.575;the AUC of LDL-C/HDL-C for predicting the occurrence of WMHs was 0.831(P<0.05,95%CI:0.754~0.917).When the interception value was 3.54,the sensitivity was 64.9%and the specificity was 85%.ApoB/ApoA1 predicted the occurrence of WMHs with an AUC of 0.740(P<0.05,95%CI:0.630~0.850).When the interception value was 0.945,the sensitivity was 52.6%and the specificity was 92.5%.Conclusion Age,TC/HDL-C,LDL-C/HDL-C,and ApoB/ApoA1 are involved in the occurrence and development of WMHs,and may be the risk factors for the onset of WMHs;TC/HDL-C,LDL-C/HDL-C,and ApoB/ApoA1 are positively correlated with the severity of WMHs in patients,among which LDL-C/HDL-C and ApoB/ApoA1 may have a predictive effect on the occurrence of WMHs.