血脂水平与缺血性脑血管病患者颈动脉狭窄关系的多中心登记研究

目的探讨血脂水平对缺血性脑血管病患者颈动脉狭窄性病变的影响。方法采用多中心横断面研究,于2015年6月至2016年5月,连续纳入20家卒中筛查与防治项目基地医院临床诊断明确的短暂性脑缺血发作或缺血性卒中住院患者10 711例。根据颈动脉超声检查结果,从中筛选出颅外段颈动脉狭窄率≥50%者1 560例,并将存在颈动脉狭窄的缺血性卒中患者分为重度狭窄(70%~99%)组及轻中度狭窄(70%)组。分析血总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)等水平在两组颈动脉狭窄人群中的分布,并依据血脂正常值范围进行量化分类,应用非参数检验比较两组患者不同级别血脂水平分布的差异。结果颈动脉重度狭窄组高脂血症发生率高于轻中度狭窄组,组间差异有统计学意义54.4%(319/586)比48.3%(470/974),P0.05],高脂血症为颈动脉重度狭窄的独立危险因素(OR=1.27,95%CI:1.24~1.30,P0.01)。颈动脉重度狭窄组患者TC及LDL-C水平均明显高于轻中度狭窄组TC:3.98(3.31,4.82)mmol/L比3.91(3.31,4.53)mmol/L;LDL-C:2.48(1.86,3.14)比2.30(1.79,2.80);均P0.01],随着TC和LDL-C水平的升高,重度狭窄与轻中度狭窄组间差异均有统计学意义(均P0.05),且重度狭窄组患者TC5.80 mmol/L的比率高于轻中度狭窄组7.3%(43/586)比0.4%(4/974)],LDL-C3.12 mmol/L的比率高于轻中度狭窄组26.3%(154/586)比10.0%(97/974)]。结论高LDL-C和TC水平可增加颈动脉重度狭窄或闭塞性病变的发生率。

Correlation between serum lipid level and carotid artery stenosis in patients with ischemic cerebrovascular disease:a multi-center registry study

Objective To investigate the effect of serum lipid level on carotid artery stenosis in patients with ischemic cerebrovascular disease.Methods Using a multi-center cross-sectional study,10 711 consecutive inpatients with transient ischemic attack (TIA) or ischemic stroke diagnosed clearly in 20 stroke screening and prevention project base hospitals from June 2015 to May 2016 were enrolled.According to the results of carotid ultrasonography,1 560 patients with extracranial carotid artery stenosis rate≥50% screened were enrolled in the study.They were divided into a severe stenosis group (70%-99%) and a mild-moderate stenosis group (<70%).The distribution of total cholesterol (TC),triacylglycerol (TG),low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels in both groups of carotid stenosis patients were analyzed,and the quantitative classification was based on the normal range of serum lipids.The distributions of serum lipid levels in different grades in patients of both groups were compared with the non-parameter test.Results The incidence of dyslipidemia in the severe stenosis group was higher than that in the mild and moderate stenosis group.There was no significant difference between the two groups (54.4%319/586]vs.48.3%470/974],P<0.05).Dyslipidemia was an independent risk factor for severe carotid artery stenosis (OR,1.27,95% CI 1.24-1.30,P<0.01).The TC and LDL-C levels in patients of the severe stenosis group were significantly higher than those in the mild-moderate stenosis group (TC:3.983.31,4.82]mmol/L vs.3.913.31,4.53]mmol/L,LDL-C:2.481.86,3.14]vs.2.301.79,2.80];all P<0.01).With the increase of TC and LDL-C levels,there was significant differences between the severe stenosis group and the mild-moderate stenosis group (all P<0.05),and the proportions of TC >5.80 mmol/L (7.3%43/586]vs.0.4%4/974]) and LDL-C>3.12 mmol/L (26.3%154/586]vs.10.0%97/974]) in patients of the severe stenosis group were higher than those in the mild-moderate stenosis group (26.3%154/586]vs.10.0%97/974]).Conclusion The high LDL-C and TC levels may increase the incidence of severe carotid artery stenosis or occlusion.