高密度脂蛋白在预测大血管闭塞型急性缺血性脑卒中发病风险中的作用

The role of high-density lipoprotein in predicting the risk of acute ischemic stroke induced by large vessel occlusion

目的探讨高密度脂蛋白在预测大血管闭塞型急性缺血性脑卒中(AIS)发生中的作用和意义。方法本研究共纳入2020年8月至2023年4月首都医科大学附属北京朝阳医院急诊科收治的235例AIS患者,其中男性156例,女性79例。基于患者的临床症状及多模态头颅计算机断层扫描(CT)影像结果分为两组,非大血管闭塞型AIS组(n=66)和大血管闭塞型AIS组(n=169)。通过单因素和多因素Logistic回归分析识别大血管闭塞型AIS的独立预测因素,并利用广义加性模型研究高密度脂蛋白与大血管闭塞型AIS发生风险间的相关性及其与年龄、血氧饱和度状态间的相互作用。结果年龄[比值比(OR)=1.03,P=0.022]、高密度脂蛋白(OR=0.25,P=0.03)、血氧饱和度状态(OR=0.21,P=0.004)作为独立预测因子,可有效预测大血管闭塞型AIS的发生风险。这些因素的联合预测模型显示出较高的预测能力[曲线下面积(AUC)=0.712,P<0.01],且高密度脂蛋白与大血管闭塞型AIS发生风险呈明显负相关。结论高密度脂蛋白可能是大血管闭塞型AIS的一个独立保护因子。结合年龄和血氧饱和度状态,高密度脂蛋白能更准确预测大血管闭塞型AIS的发生风险。

Objective To investigate the role and significance of high-density lipoprotein in predicting the onset of acute ischemic stroke induced by large vessel occlusion.Methods A total of 235 patients with acute ischemic stroke(AIS)from Emergency Department of Beijing Chaoyang Hospital,Capital Medical University,were included in this study with 156 males and 79 females.Based on the clinical symptoms and multimodal cranial CT imaging results of the patients,they were divided into two groups:the non-large vessel occlusion AIS group(n=66)and the large vessel occlusion AIS group(n=169).Univariate and multivariate Logistic regression analyses were employed to identify independent predictive factors for AIS induced by large vessel occlusion.Moreover,generalized additive models were utilized to analyse the correlation between high-density lipoprotein levels and the risk of AIS induced by large vessel occlusion,as well as the interaction with age and oxygen saturation status.Results Age[odds ratio(OR)=1.03,P=0.022],high-density lipoprotein(OR=0.25,P=0.03)and oxygen saturation status(OR=0.21,P=0.004)were identified as independent predictors which could effectively forecast the occurrence of AIS induced by large vessel occlusion.The combined prediction model of these factors demonstrated high predictive ability[area under the curve(AUC)=0.712,P<0.01],and a significantly negative correlation was found between high-density lipoprotein levels and the risk of AIS induced by large vessel occlusion.Conclusions High-density lipoprotein may serve as an independent protective factor against AIS induced by large vessel occlusion.When combined with age and oxygen saturation status,high-density lipoprotein can predict the risk of AIS induced by large vessel occlusion more accurately.