神经酰胺与老年缺血性脑卒中患者颅内外动脉粥样硬化性狭窄的相关性分析

Correlation of Ceramide and Intracranial and Extracranial Atherosclerotic Stenosis in Elderly Patients with Ischemic Stroke

目的探讨老年缺血性脑卒中(ischemic stroke,IS)患者神经酰胺(ceramide,Cer)、甘油三酯-葡萄糖指数(triglyceride-glucose index,TyG指数)、残余胆固醇(residual cholesterol,RC)水平对颅内外动脉粥样硬化性狭窄的评估价值。方法选取2022年1月~2023年6月于徐州医科大学附属医院住院治疗的老年IS患者447例,根据头颈部数字减影血管造影(digital subtraction angiography,DSA)所示动脉管腔情况将患者分为非狭窄组(n=144)和狭窄组(n=303),其中狭窄组进一步分为中度狭窄组(n=121)和重度狭窄+闭塞组(n=182)。收集所有患者的一般资料及基线生化资料,采用高效液相色谱串联质谱法检测患者血清Cer,计算TyG指数和RC水平。采用Spearman法分析Cer、TyG指数、RC与颅内外动脉粥样硬化性狭窄的相关性,多因素Logistic回归分析确定颅内外动脉粥样硬化性狭窄的危险因素。结果与非狭窄组比较,狭窄组Cer、TyG指数、RC、Lp(a)、糖化血红蛋白等指标明显增高(P<0.05)。多因素Logistic回归分析结果显示,Cer16:0、Cer18:0、Cer24:1、Cer24:1/Cer24:0、Cer18:0/Cer24:0、Cer16:0/Cer24:0是老年IS患者患者颅内外动脉粥样硬化性狭窄的独立危险因素。Spearman相关性分析结果显示,Cer24:0与颅内外动脉粥样硬化性狭窄呈负相关(r=-0.122,P<0.05)。受试者工作特征曲线分析结果显示,Cer24:1、Cer24:1/Cer24:0、Cer18:0/Cer24:0、Cer16:0/Cer24:0,RC、TyG指数诊断老年IS患者颅内外动脉粥样硬化性狭窄的曲线下面积分别为0.832、0.846、0.826、0.829、0.578、0.586(P<0.05)。结论老年IS患者的血清Cer、TyG指数、RC水平较高,可能是老年IS患者颅内外动脉粥样硬化性狭窄的危险因素。

Objective To investigate the valuation of ceramide(Cer),trigly ceride-glucose index(TyG index)and residual cholesterol(RC)levels on intracranial and extracranial atherosclerotic stenosis in elderly patients with ischemic stroke(IS).Methods A total of 447 elderly patients with IS who were hospitalized in the Affiliated Hospital of Xuzhou Medical University from January 2022 to June 2023 were selected.According to the digital subtraction angiography(DSA)results,the patients were divided into non-stenosis group(n=144)and stenosis group(n=303).The stenosis group was further divided into moderate stenosis group(n=121),severe stenosis and occlusion group(n=182).The general information and baseline biochemical data of all patients were collected.High performance liquid chromatography tandem mass spectrometry was used to detect serum Cer,and TyG index and RC level were calculated.Spearman method was used to analyze the correlation between Cer,TyG index,RC and intracranial and extracranial atherosclerotic stenosis.Multivariate Logistic regression was used to analyze the risk factors of intracranial and extracranial atherosclerotic stenosis.Results Compared with the non-stenosis group,Cer,TyG index,RC,Lp(a),and glycosylated hemoglobin(HbA1c)and other indexes were significantly increased in the stenosis group(P<0.05).Multivariate Logistic regression analysis showed that Cer16:0,Cer18:0,Cer24:1,Cer24:1/Cer24:0,Cer18:0/Cer24:0,Cer16:0/Cer24:0 were independent risk factors for intracranial and extracranial atherosclerotic stenosis in elderly patients with IS.Spearman correlation analysis showed that Cer24 was negatively correlated with intracranial and extracranial atherosclerotic stenosis(r=-0.122,P<0.05).The results of receiver operating characteristic curve showed that,the areas under the curve of Cer24:1,Cer24:1/Cer24:0,Cer18:0/Cer24:0,Cer16:0/Cer24:0,RC,TyG index in the diagnosis of intracranial and extracranial atherosclerotic stenosis in elderly patients with IS were 0.832,0.846,0.826,0.829,0.578,0.586(P<0.05).Conclusion The serum levels of serum Cer,TyG index and RC are higher in elderly patients with IS,which may be the risk factors for intracranial and extracranial atherosclerotic stenosis in elderly patients with IS.