脑梗死患者Hcy/HDL-C比值变化及临床意义

Changes and clinical significance of Hcy/HDL-C ratio in patients with cerebral infarction

目的探讨脑梗死患者同型半胱氨酸(Hcy)/高密度脂蛋白胆固醇(HDL-C)比值变化及临床意义。方法回顾性选取2022年1月至2023年6月该院148例脑梗死患者作为病例组,另收集同期148例健康体检者作为对照组。比较病例组和对照组Hcy、HDL-C水平及Hcy/HDL-C比值;比较病例组不同神经功能缺损程度、梗死灶体积、预后患者Hcy、HDL-C水平及Hcy/HDL-C比值;采用Kendall′s Tau-b检验对Hcy、HDL-C水平及Hcy/HDL-C比值与神经功能缺损程度、梗死灶体积的相关性进行分析;绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)评估Hcy、HDL-C及Hcy/HDL-C对脑梗死患者预后的预测价值。结果病例组Hcy水平、Hcy/HDL-C比值均明显高于对照组,HDL-C水平明显低于对照组,差异均有统计学意义(P<0.05)。轻度神经功能缺损患者Hcy水平、Hcy/HDL-C比值均低于中、重度神经功能缺损患者,HDL-C水平高于中、重度神经功能缺损患者,差异均有统计学意义(P<0.05);中度神经功能缺损患者Hcy水平、Hcy/HDL-C比值均低于重度神经功能缺损患者,HDL-C水平高于重度神经功能缺损患者,差异均有统计学意义(P<0.05)。小梗死灶患者Hcy水平、Hcy/HDL-C比值均低于中、大梗死灶患者,HDL-C水平高于中、大梗死灶患者,差异均有统计学意义(P<0.05);中梗死灶患者Hcy水平、Hcy/HDL-C比值均明显低于大梗死灶患者,HDL-C水平明显高于大梗死灶患者,差异均有统计学意义(P<0.05)。相关性分析结果显示,Hcy水平、Hcy/HDL-C比值与神经功能缺损程度、梗死灶体积均呈正相关(P<0.05);HDL-C水平与神经功能缺损程度、梗死灶体积均呈负相关(P<0.05)。预后良好患者Hcy水平、Hcy/HDL-C比值均明显低于预后不良患者,HDL-C水平明显高于预后不良患者,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,Hcy、HDL-C及Hcy/HDL-C对脑梗死患者预后均具有中等预测价值,且以Hcy/HDL-C的预测价值最高,AUC分别为0.741、0.753、0.820。结论脑梗死患者Hcy水平、Hcy/HDL-C比值均呈升高状态,HDL-C水平呈降低状态,Hcy、HDL-C水平及Hcy/HDL-C比值与神经功能损伤程度、梗死灶体积均有关;Hcy、HDL-C及Hcy/HDL-C对脑梗死患者预后均有一定的预测价值,且以Hcy/HDL-C的预测价值最高。

Objective To investigate the changes and clinical significance of homocysteine(Hcy)/high density lipoprotein cholesterol(HDL-C)in patients with cerebral infarction.Methods A total of 148 patients with cerebral infarction in the hospital from January 2022 to June 2023 were retrospectively selected as the case group,and a total of 148 healthy people in the same period were collected as the control group.The levels of Hcy,HDL-C and Hcy/HDL-C ratio were compared between the case group and the control group.The levels of Hcy,HDL-C and Hcy/HDL-C ratio in patients with different degrees of neurological deficit,infarct volume and prognosis were compared.Kendall′s Tau-b test was used to analyze the correlation between the levels of Hcy,HDL-C,Hcy/HDL-C ratio and the degree of neurological deficit and infarct volume.The receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was used to evaluate the predictive value of Hcy,HDL-C and Hcy/HDL-C for the prognosis of patients with cerebral infarction.Results The levels of Hcy and Hcy/HDL-C ratio in the case group were significantly higher than those in the control group,and the level of HDL-C was significantly lower than that in the control group,and the differences were statistically significant(P<0.05).The levels of Hcy and Hcy/HDL-C ratio in patients with mild neurological impairment were lower than those in patients with moderate and severe neurological impairment,and the level of HDL-C was higher than that in patients with moderate and severe neurological impairment,and the differences were statistically significant(P<0.05).The levels of Hcy and Hcy/HDL-C ratio in patients with moderate neurological deficit were lower than those in patients with severe neurological deficit,and the level of HDL-C was higher than that in patients with severe neurological deficit,and the differences were statistically significant(P<0.05).The levels of Hcy and Hcy/HDL-C ratio in patients with small infarcts were lower than those in patients with medium and large infarcts,and the level of HDL-C was higher than that in patients with medium and large infarcts,and the differences were statistically significant(P<0.05).The levels of Hcy and Hcy/HDL-C ratio in patients with middle infarcts were significantly lower than those in patients with large infarcts,and the level of HDL-C was significantly higher than that in patients with large infarcts,and the differences were statistically significant(P<0.05).The correlation analysis results showed that Hcy levels and Hcy/HDL-C ratio were positively correlated with the degree of neurological deficit and infarct volume(P<0.05).The level of HDL-C was negatively correlated with the degree of neurological deficit and the volume of infarct(P<0.05).The levels of Hcy and Hcy/HDL-C ratio in patients with good prognosis were significantly lower than those in patients with poor prognosis,and the level of HDL-C was significantly higher than that in patients with poor prognosis,and the differences were statistically significant(P<0.05).ROC curve analysis showed that Hcy,HDL-C and Hcy/HDL-C had moderate predictive value for the prognosis of patients with cerebral infarction,and Hcy/HDL-C had the highest predictive value,with AUC of 0.741,0.753 and 0.820 respectively.Conclusion The levels of Hcy and Hcy/HDL-C ratio in patients with cerebral infarction increase,while HDL-C level decrease.Hcy,HDL-C and Hcy/HDL-C levels are related to the degree of neurological damage and the volume of infarction.Hcy,HDL-C and Hcy/HDL-C have certain predictive value for the prognosis of patients with cerebral infarction,and Hcy/HDL-C has the highest predictive value.