低高密度脂蛋白胆固醇血症对缺血性脑卒中患者一年预后的影响

目的分析低HDL-C与急性缺血性脑卒中患者1年预后的关系。方法以前瞻性、多中心的中国国家卒中登记研究数据库中符合标准的住院患者8876例为研究对象,男性5555例,女性3321例。将HDL-C<0.9mmol/L的1440例患者作为低HDL-C,HDL-C≥0.9mmol/L的7436例患者作为正常HDL-C。采用多变量logistic回归模型分析低水平HDL-C对缺血性脑卒中患者1年预后的影响。结果 8867例患者中低HDL-C发生率16.2%。低HDL-C与正常HDL-C患者基线血压、LDL-C和TG水平比较,差异有统计学意义(P<0.05,P<0.01)。男性低HDL-C患者1年预后不良发生率明显高于正常HDL-C患者(27.9%vs 24.1%,P<0.05)。低HDL-C是男性脑卒中1年预后不良的独立危险因素(OR=1.289,95%CI:1.068¹.555,P=0.008)。基线LDL-C<2.59mmol/L患者中,低HDL-C水平仍是男性脑卒中患者1年预后不良的独立危险因素(OR=1.528,95%CI:1.1621.555,P=0.008)。基线LDL-C<2.59mmol/L患者中,低HDL-C水平仍是男性脑卒中患者1年预后不良的独立危险因素(OR=1.528,95%CI:1.162².010,P=0.002)。结论低HDL-C是男性缺血性脑卒中患者发病1年预后不良的独立危险因素,并且独立于基线LDL-C水平。LDL-C水平越低,升高HDL-C的临床获益越大。

Effect of low HDL-C on one-year outcome in patients with acute ischemic stroke

Objective To analyze the relation between low HDL-C and 1-year outcome in patients with acute ischemic stroke(AIS).Methods A total of 8876patients(5555males and 3321females)admitted to our hospital who met the diagnostic criteria for AIS in China National Stroke Registry were included in this study.The patients were divided into HDL-C<0.9mmol/L group(n=1440)and HDL-C≥0.9mmol/L group(n=7436).Effect of low HDL-C on the 1-year outcome in AIS patients was analyzed by multiple logistic regression analysis.Results The incidence of low HDL-C was 16.2%in the 8867AIS patients.The bascline blood pressure,serum LDL-C and TG levels were significantly different between the two groups(P<0.05,P<0.01).The1-year outcome was significantly poorer in male patients with their serum HDL-C level<0.9mmol/L than in those with their serum HDL-C level≥0.9 mmol/L(27.9% vs 24.1%,P<0.05).low HDL-C was an independent risk factor for the 1-year poor outcome in male AIS patients(OR=1.289,95%CI:1.068-1.555,P=0.008)and in those with their serum LDL-C level<2.59mmol/L(OR=1.528,95%CI:1.162-2.010,P=0.002).Conclusion Low HDL-C is an independent risk factor for the 1-year year poor outcome in male AIS patients,which is independent of the baseline LDL-C level.The lower the LDL-C level is,the greater the clinical benefit of HDL-C level is.