血清Galectin-3和HDL-C水平检测对急性缺血性脑卒中预后的影响研究

目的　探讨血清半乳糖蛋白-3（Galectin-3）和高密度脂蛋白胆固醇（high density lipoprotein cholesterol, HDL-C）浓度对急性缺血性脑卒中（acute ischemic stroke,AIS）预后的影响。方法　选择2014年1月～2019年6月广西壮族自治区江滨医院诊治的AIS患者1 104例进行前瞻性研究，按Galectin-3（<8.65ng/ml和≥8.65ng/ml）和HDL-C（<0.9mmol/L和≥0.9mmol/L）水平将其分为低Galectin-3/高HDL-C组，低Galectin-3/低HDL-C组，高Galectin-3/高HDL-C组和高Galectin-3/低HDL-C组，采用Kaplan-Meier及Cox风险模型分析Galectin-3/HDL-C水平对AIS患者随访6~12个月预后结局（心血管事件和死亡复合结局、复发性脑卒中、心血管事件、死亡），采用受试者工作特征曲线（receiver operating characteristic curve, ROC）分析Galectin-3/HDL-C水平对AIS患者心血管事件和死亡复合结局的预测价值。结果　1 104例患者中，失访36人，共1 068例患者入组，与低Galectin-3/高HDL-C组相比，高Galectin-3/低HDL-C组随访6~12个月内发生心血管事件和死亡的复合结局、复发性脑卒中、心血管事件的HR（95%CI）分别为1.56(1.08~2.22)，1.84(1.10~2.98)，1.95(1.26~2.98)和1.35(0.85~2.15)，主要结局和次要结局的发生率明显升高（均P<0.05）；Kaplan-Meier曲线示与低Galectin-3/高HDL-C组相比，高Galectin-3/低HDL-C组发生心血管事件和死亡复合结局发生率高（Log rank检验，χ2=4.189，P<0.001）；ROC曲线示Galectin-3和HDL-C对缺血性脑卒中患者不良预后具有预测价值（χ2=3.85，P=0.002）。结论　基线血清高Galectin-3/低HDL-C水平组与缺血性脑卒中后6~12个月内发生不良结局相关，对卒中不良预后具有预测价值。

Effect of Serum Galectin-3 and HDL-C Levels on Prognosis of AcuteIschemic Stroke

Objective　To investigate the effects of serum Galectin-3 and high-density lipoprotein cholesterol (HDL-C)concentrations on the prognosis of acute ischemic stroke (AIS). Methods　A prospective study was conducted on 1 104 patientswith AIS treated in Jiangbin Hospital of Guangxi Zhuang Autonomous Region from January 2014 to June 2019. According toGalectin-3 (<8.65ng/ml and ≥ 8.65ng/ml) and HDL-C (<0.9mmol/L and ≥ 0.9mmol/L) levels could be divided into four groups(low Galectin-3/ high HDL-C, low Galectin-3/low HDL-C, high Galectin-3/high HDL-C and high Galectin-3/low HDL-C).Kakathr-Meier and Cox risk model were used to analyze the prognosis of Galectin-3 /HDL-C level in AIS patients followed upfor 6~12 months (compound outcome of cardiovascular events and death, recurrent stroke, cardiovascular events and death), andthe receiver operating Characteristic curve (ROC) was used to analyze the predictive value of Galectin-3/HDL-C level in complexoutcome of cardiovascular events and death in AIS patients. Results　Of 1 104 patients, 36 were lost to follow-up, a total of1 068 were enrolled. Compared with the low Galectin-3/ high HDL-C group, the combined outcome of cardiovascular events anddeath, recurrent stroke, and cardiovascular events HR (95%CI)] in the high Galectin-3/ low HDL-C group were 1.56(1.08~2.22),1.84(1.10~2.98), 1.95(1.26~2.98) and 1.35(0.85~2.15) during 6~12 months of follow-up, respectively. The incidence of primaryand secondary outcomes was significantly higher in the high Galectin-3/ low HDL-C group (all P<0.05). Kaplan-Meier curveshowed a high incidence of cardiovascular events and death composite outcomes in the high Galectin-3/ low HDL-C group thanin the low Galectin-3/ high HDL-C group (Log rank test, χ2=4.189, P<0.001). ROC curve showed that Galectin-3 and HDL-Chad predictive value for poor prognosis of patients with ischemic stroke(χ2=3.85, P=0.002). Conclusion　Baseline serum highGalectin-3/ low HDL-C levels were associated with adverse outcomes within 6~12 months after ischemic stroke, which haspredictive value for poor prognosis of stroke.