LDL-C、HDL-C动态评估在急性脑梗死溶栓患者预后中的意义

Implications of dynamic measurement of LDL-C,HDL-C and their ratios in the prognosis of patients with acute cerebral infarction undergoing thrombolysis

目的:探讨动态评估低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及其比值在急性脑梗死(ACI)溶栓患者预后中的价值。方法:回顾性收集并分析2020年1月~2022年12月于太和县人民医院神经内科就诊并接受rt-PA静脉溶栓治疗的121例ACI患者临床资料,根据患者90 d后mRS评分状况分为预后不良组(n=33)和预后良好组(n=88),检测并比较两组患者溶栓内1 d、溶栓后1个月LDL-C、HDL-C水平差异,并运用受试者工作特征曲线(ROC)评估以上指标的预测价值。结果:预后不良组的NIHSS评分、梗死体积、发病至溶栓的时间、合并高血压比例均高于预后良好组(P<0.05),体质量指数(BMI)低于预后良好组(P<0.05);两组患者溶栓后1个月LDL-C、LDL-C/HDL-C比值较溶栓内1d均下降,HDL-C值上升(P<0.05);且预后良好组HDL-C上升幅度优于预后不良组(P<0.05);多因素Logistic回归分析结果显示,BMI低(OR=0.730,95%CI:0.552~0.966)、梗死体积大(OR=1.088,95%CI:1.014~1.167)、发病至溶栓的时间长(OR=1.012,95%CI:1.000~1.023)、合并高血压(OR=4.911,95%CI:1.599~15.083)、HDL-C差值小(OR=0.753,95%CI:0.571~0.992)是影响ACI患者预后不良的独立危险因素(P<0.05);HDL-C差值预测的AUC面积为0.718(P<0.05)。结论:动态评估HDL-C的水平变化对判断ACI患者静脉溶栓后不良预后具有重要的临床价值。

Objective:To dynamically measure the level of low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)and their ratios in estimation of the prognosis of thrombolytic patients with acute cerebral infarction(ACI).Methods:Retrospective analysis was conducted on the clinical data of 121 ACI patients who received rt-PA intravenous thrombolysis treatment in the Neurology Department of Taihe County People′s Hospital from January 2020 to December 2022.The cases were divided into a poor prognosis group(n=33)and a good prognosis group(n=88)based on their 90 day mRS score.LDL-C and HDL-C levels were measured on the first day of thrombolysis and one month after thrombolysis,and the differences in levels between the two groups were compared.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the above indicators.Results:In univariate analysis,the NIHSS score,infarct volume,time from onset to thrombolysis,and the proportion of concomitant hypertension in the poor prognosis group were higher than those in the good prognosis group,and the body mass index were lower than those in the good prognosis group(all P<0.05).After 1 day of thrombolysis,the LDL-C and LDL-C/HDL-C ratios of both groups of patients were decreased,whereas the HDL-C values were increased(P<0.05),and HDL-C increase in the good prognosis group was significantly higher than that in the poor prognosis group(P<0.05).The results of multivariate logistic regression analysis showed that low body mass index(OR=0.730,95%CI:0.552-0.966),large infarct volume(OR=1.088,95%CI:1.014-1.167),long time from onset to thrombolysis(OR=1.012,95%CI:1.000-1.023),concomitant hypertension(OR=4.911,95%CI:1.599-15.083),and low HDL-C difference(OR=0.753,95%CI:0.571-0.992)were independent risk factors for poor prognosis in ACI patients(P<0.05).The ROC results indicated the area under the HDL-C difference prediction curve being 0.718(P<0.05).Conclusion:Dynamic measurement of the levels of HDL-C has important clinical value in predicting poor prognosis in ACI patients after intravenous thrombolysis.