极低密度脂蛋白与急性脑梗死患者静脉溶栓后出血性转化风险的相关性研究

Correlation between the level of very low density lipoprotein and the risk of bleeding transformation after intravenous thrombolysis in patients with acute cerebral infarction

目的探讨极低密度脂蛋白(VLDL)水平与急性脑梗死(ACI)患者静脉溶栓治疗后出血性转化(HT)发生的关系。方法本研究为队列研究,选取2020年2月至2023年2月于延安大学咸阳医院神经内科行静脉溶栓治疗的166例ACI患者。男93例,女73例,年龄(64.11±6.69)岁,年龄范围为44~78岁。患者均接受静脉溶栓治疗,同时收集入院时静脉血样,测定血清VLDL水平。静脉溶栓完成后14 d复查颅脑CT。多因素logistic回归分析法确定血清VLDL水平与ACI静脉溶栓后HT发生的关系。结果静脉溶栓后45例患者发生HT,HT发生率为27.1%。依据是否出现HT,将患者分为NHT组和HT组,NHT为未发生HT患者,HT组为发生HT患者。HT组合并心房颤动[22.2%(10/45)]、入院时美国国立卫生研究院卒中量表评分≥9分患者比例[46.7%(21/45)]均高于NHT组[6.6%(8/121),24.0%(29/121)],血清VLDL[(1.09±0.22)mmol/L]、低密度脂蛋白胆固醇(LDL-C)水平[(3.28±0.52)mmol/L]均高于NHT组[(0.84±0.24)mmol/L,(2.97±0.53)mmol/L],差异有统计学意义(P<0.05)。logistic回归分析显示,血清VLDL水平高(OR=5.073,95%CI:3.780~11.946)及LDL-C水平高(OR=1.435,95%CI:1.183~6.062)是影响ACI静脉溶栓后HT发生的独立危险因素(P<0.05)。受试者操作特征曲线分析显示,血清VLDL与LDL-C对ACI溶栓后HT发生具有一定预测价值(曲线下面积=0.767,曲线下面积=0.661),且VLDL联合LDL-C检测能显著提高预测价值(Z=3.916,Z=5.599,P<0.05)。结论血清VLDL升高与ACI静脉溶栓后HT发生有关,临床可通过检测入院患者VLDL预估HT发生风险,且VLDL联合LDL-C检测能提高预测价值。

Objective To explore the relationship between the level of very low density lipoprotein(VLDL)and the occurrence of hemorrhagic transformation(HT)in patients with acute cerebral infarction(ACI)after intravenous thrombolysis.Methods This study was a cohort study,a total of 166 patients with ACI who underwent intravenous thrombolysis in the department of Neurology of Xianyang Hospital of Yan′an University from February 2020 to February 2023 were selected,there were 93 males and 73 females,aged(64.11±6.69)years old,ranging from 44 to 78 years old.All patients received intravenous thrombolytic therapy,and venous blood samples were collected at admission to determine serum VLDL levels.Craniocerebral CT was re-examined 14 d after completion of intravenous thrombolysis.Multivariate logistic regression analysis was used to determine the relationship between serum VLDL level and the occurrence of HT after ACI intravenous thrombolysis.Results There were 45 patients with HT after intravenous thrombolysis,the incidence of HT was 27.1%.According to the presence or absence of HT,the patients were divided into NHT group and HT group,in which NHT group were non-HT patients and HT group were HT patients.The proportion of patients with atrial fibrillation in HT group[22.2%(10/45)]and National Institutes of Health Stroke Scale≥9 points at admission[46.7%(21/45)]was higher than that in NHT group[6.6%(8/121),24.0%(29/121)],serum levels of VLDL[(1.09±0.22)mmol/L]and LDL-C[(3.28±0.52)mmol/L]were significantly higher than those of NHT group[(0.84±0.24)mmol/L,(2.97±0.53)mmol/L],and the differences were statistically significant(P<0.05).Logistic regression analysis showed that serum VLDL high level(OR=5.073,95%CI:3.780 to 11.946)and LDL-C high level(OR=1.435,95%CI:1.183 to 6.062)were independent risk factors for HT after intravenous thrombolysis of ACI(P<0.05).Receiver operating characteristic curve analysis showed that serum VLDL and LDL-C had certain predictive value for HT occurrence after ACI thrombolytic therapy(area under the curve=0.767,area under the curve=0.661),and VLDL combined with LDL-C detection could significantly improve the predictive value(Z=3.916,Z=5.599,P<0.05).Conclusions The increase of serum VLDL is related to the occurrence of HT after intravenous thrombolysis in ACI.the risk of HT can be predicted by detecting VLDL in hospitalized patients,and the combined detection with LDL can improve the predictive value.