血脂指标的比值在预测心脑疾病患者颈动脉内-中膜增厚中的作用

目的评价颈动脉内-中膜厚度（CIMT）与血脂（包括脂质、脂蛋白、载脂蛋白）、超敏C反应蛋白（hs-CRP）、空腹血糖、年龄、性别等因素间的相关性。方法回顾性分析2009年9月—2010年3月在广州市红十字会医院神经内科和心内科住院,年龄≥40岁的833例患者的临床资料,包括采用超声测量的平均CIMT、性别、年龄、血脂水平脂质、脂蛋白、载脂蛋白,以及脂质比值,包括低密度脂蛋白胆固醇（LDL-C）与高密度脂蛋白胆固醇（HDL-C）的比值、载脂蛋白B（Apo-B）与载脂蛋白A-Ⅰ（ApoA-Ⅰ）的比值及总胆固醇（TC）与HDL-C的比值]、hs-CRP、空腹血糖等资料。依据患者的CIMT,分为正常组（平均CIMT〈1.0 mm）172例,增厚组（平均CIMT≥1.0 mm）661例。采用二元Logistic回归分析筛选出CIMT增厚的独立危险因素。结果①增厚组患者的年龄、空腹血糖、hs-CRP、LDL-C/HDL-C比值、TC/HDL-C比值、Apo-B/ApoA-Ⅰ比值的中位数,均高于正常组,而HDL-C、ApoA-Ⅰ的中位数低于正常组。增厚组男性例数要明显多于正常组,差异有统计学意义,均P〈0.05。两组之间其他变量差异无统计学意义。②二元Logistic回归显示,年龄（OR=1.085,95%CI：1.067～1.104）、男性（OR=1.897,95%CI：1.985～2.799）、hs-CRP（OR=1.165,95%CI：1.047～1.296）、LDL-C/HDL-C比值（OR=1.281,95%CI：1.040～1.579）是预测CIMT增厚的独立危险因素。结论 LDL-C/HDL-C比值增高是预测心脑疾病患者CIMT增厚的独立危险因素,其预测作用可能要优于单独检测LDL-C或HDL-C。

Effectiveness of lipds ratio as a predictor of increased carotid intima-media thickness patients with cardio-cerebrovascular diseases

Objective To evaluate the correlations between carotid intima-media thickness(CIMT) and blood lipids(including lipids,lipoproteins and apolipoproteins),high sensitivity C-reactive protein(hs-CRP),fasting glucose,age,and sex et al.Methods The clinical data of 833 patients aged ≥ 40 years of age in the Departments of Neurology and Cardiology,the Affiliated Dongguan Hospital,School of Medicine,Jinan University from September 2009 to March 2010 were analyzed retrospectively,including ultrasound-derived mean CIMT,age,sex,the levels of serum lipids(including lipids,lipoprotein,apolipoprotein,and lipids ratio,such as LDL-C/HDL-C,total cholesterol/HDL-C,apolipoprotein B/apolipoprotein A1 ratio),hs-CRP,fasting glucose.The patients were divided into either a normal group(the mean CIMT < 1.0 mm,n=172) or a thickening group(the mean CIMT ≥ 1.0 mm,n=661) according to their CIMT.A binary logistic regression analysis was use to identify the independent risk factors for increased CIMT.Results ①The median of age,fasting glucose,hs-CRP,low-density lipoprotein cholesterol/high density lipoprotein cholesterol(LDL-C/HDL-C) ratio,total cholesterol(TC)/HDL-C ratio,and apolipoprotein B/apolipoprotein A-Ⅰ ratio in the thickening group were significantly higher than those in the normal group,and the median of HDL-C and apolipoprotein A-Ⅰ were lower than those in the normal group.The number of men in the thickening group was obviously more than that in the normal group.There was significant differences(all P<0.05).There were no significant differences in other variables between the 2 groups.②Binary logistic regression analysis showed that significant risk factors associated with increased CIMT were age(OR,1.085,95%CI 1.067-1.104),man(OR,1.897,95%CI 1.985-2.799),hs-CRP(OR,1.165,95%CI 1.047-1.296),and LDL-C/HDL-C ratio(OR,1.281,95%CI 1.040-1.579).Conclusion The age,male,hs-CRP,and LDL-C/HDL-C ratio were the independent risk factors for increased CIMT.LDL-C/HDL-C in the prediction of increased CIMT may be superior to the separate detection of LDL-C or HDL-C.