血脂变异性与缺血性卒中患者脑血管事件复发的相关性

Correlation between blood lipid variability and recurrence of cerebrovascular events in patients with ischemic stroke

目的探讨血脂变异性与缺血性卒中患者脑血管事件复发的相关性。方法前瞻性纳入2020年6月1日至2022年12月31日在青岛市市立医院就诊的缺血性卒中患者,并进行为期30个月的随访。计算随访期间总胆固醇(total cholesterol,TC)、甘油三酯(triglycerides,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)和高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)的标准差(standard deviation,SD)和变异系数(coefficient of variation,CV),比较随访前后患者的血脂达标率。对脑血管事件复发情况进行监测,包括缺血性卒中、脑出血和短暂性脑缺血发作。通过Cox比例风险回归模型分析TC、LDL-C、HDL-C和TG变异性与脑血管事件复发的相关性。结果共纳入142例缺血性卒中患者,男性81例(57.0%),年龄(63.4±5.8)岁,34例(23.9%)在随访期间出现复发性脑血管事件。随访结束时,患者TC、TG和LDL-C较随访前显著下降(P均<0.05),血脂达标率较随访前显著升高(51.4%对12.7%;P=0.001)。其中,复发组LDL-C变异系数显著高于未复发组患者(P=0.005)。Cox比例风险回归模型分析显示,校正年龄、性别、体重指数、基线血脂、基线血压后,随访期间的LDL-C[SD:风险比(hazard risk,HR)4.051,95%置信区间(confidence interval,CI)2.671~5.687,P=0.034;CV:HR 3.785,95%CI 2.356~5.013,P=0.041]和TC变异性(SD:HR 3.821,95%CI 2.450~5.224,P=0.039;CV:HR 3.715,95%CI 2.401~5.036,P=0.042)与脑血管事件复发独立相关。结论LDL-C和TC变异性是缺血性卒中患者脑血管事件复发的独立影响因素。监测缺血性卒中患者的LDL-C和TC变异性并及时干预,有可能降低脑血管事件的复发风险。

ObjectiveTo investigate the correlation between blood lipid variability and recurrence of cerebrovascular events in patients with ischemic stroke.MethodsPatients with ischemic stroke admitted to Qingdao Municipal Hospital from June 1,2020 to December 31,2022 were prospectively enrolled and followed up for 30 months.The standard deviation(SD)and coefficient of variation(CV)of total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C)were calculated during follow-up,and the attainment rate of blood lipid before and after follow-up were compared.The recurrence of cerebrovascular events was monitored,including ischemic stroke,cerebral hemorrhage,and transient ischemic attack.Cox proportional hazards regression model was used to analyze the correlation between the variability of TC,LDL-C,HDL-C,and TG and the recurrence of cerebrovascular events.ResultsA total of 142 patients with ischemic stroke were enrolled,including 81 males(57.0%),aged 63.4±5.8 years.During follow-up,34 patients(23.9%)experienced recurrent cerebrovascular events.At the end of the follow-up,TC,TG,and LDL-C levels decreased significantly compared to before the follow-up(all P<0.05),and the attainment rate of blood lipid increased significantly compared to before the follow-up(51.4%vs.12.7%;P=0.001).CV of LDL-C in the recurrent group was significantly higher than that in the non-recurrent group(P=0.005).Cox proportional hazards regression analysis showed that after adjusting for age,gender,body mass index,baseline blood lipids,and baseline blood pressure,LDL-C variability(SD:hazard risk[HR]4.051,95%confidence interval[CI]2.671-5.687,P=0.034;CV:HR 3.785,95%CI 2.356-5.013,P=0.041)and TC variability(SD:HR 3.821,95%CI 2.450-5.224,P=0.039;CV:HR 3.715,95%CI 2.401-5.036,P=0.042)during follow-up were independently associated with the recurrence of cerebral vascular events.ConclusionsLDL-C and TC variability are the independent influencing factors for the recurrence of cerebrovascular events in patients with ischemic stroke.Monitoring the variability of LDL-C and TC in patients with ischemic stroke and intervening in a timely manner may reduce the risk of recurrence of cerebrovascular events.