小而密低密度脂蛋白胆固醇联合同型半胱氨酸检测对脑梗死老年患者预后评估的价值

目的 分析血清小而密低密度脂蛋白胆固醇(sdLDL-C)联合同型半胱氨酸(Hcy)检测对预测脑梗死老年患者预后评估的价值.方法 选择马鞍山市人民医院2015年2月至2016年2月就诊的46例罹患脑梗死老年患者作为研究对象.检测患者血清sdLDL-C 、Hcy、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、糖化血红蛋白(HbA1c).随访1年根据是否脑卒中复发及全因死亡进行分组,预后良好组(未发生终点事件)和预后不良组(发生终点事件).应用logistic回归分析随访1年发生终点事件的危险因素;应用ROC曲线评估血清sdLDL-C及Hcy水平预测脑梗死老年患者随访1年发生终点事件的特异度和敏感度.结果 与预后良好组相比,预后不良组血清sdLDL-C、Hcy、LDL-C及HbA1c较高(P＜0.05),HDL-C较低(P＜0.05),但TC及FBG差异无统计学意义(P＞0.05).多元logistic回归分析,血清sdLDL-C、Hcy水平是脑梗死老年患者随访1年发生终点事件的危险因素(P＜0.05).ROC曲线评估血清sdLDL-C、HCY水平预测脑梗死老年患者随访1年发生终点事件有显著预测价值(P＜0.05),且判定血清sdLDL-C为1.31 mmol/L、血清Hcy为19.9 μmol/L对预测随访1年发生终点事件有88.9％的灵敏和84.6％的特异度.结论 血清sdLDL-C及Hcy检测能有效预测脑梗死老年患者短期发生终点事件的危险性.

The clinical value of small dense low-density lipoprotein cholesterol and Hcy on prognosis of elderly patients with cerebral infarction

Objective To analyze the clinical value of serum small dense low-density lipoprotein cholesterol (sdLDL-C) and homocysteine (Hcy) on the prognosis of elderly patients with cerebral infarction (CI).Methods Forty-six elderly patients diagnosed as CI in our hospital were collected as subjects.The serum levels of sdLDL-C,Hcy,total cholesterol (TC),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),fasting blood-glucose (FBG),glycosylated hemoglobin (HbAlc) were detected respectively.After one year follow-up,all elderly patients were divided into two groups according to the recurrence of stroke and all-cause death,which was good prognosis group (the non-recurrence of endpoint event) and poor prognosis group (the recurrence of endpoint event).The above indexes were compared between two groups.The risk factors of the recurrence of stroke of the one year prognosis were evaluated by multivariate logistic regression analysis.The values of serum sdLDL-C and Hcy level in the recurrence of stroke of the one year prognosis were anaylsed by the ROC curve.Results Compared to the good prognosis group,the serum levels of sdLDL-C,Hey,LDL-C and HbA1 c of the poor prognosis group were higher (P ＜ 0.05),the serum levels of HDL of the poor prognosis group were lower (P ＜0.05),but the serum levels of TC and FBG of the poor prognosis group had no difference (P ＞ 0.05).The serum levels of sdLDL-C and Hcy were confirmed to the risk factors of the recurrence of endpoint event of the one year prognosis in elderly patients with CI by multivariate logistic regression analysis.The ROC curve identified the cutoff levels of serum sdLDL-C (1.31 rmmoL/L) and Hcy (19.9 μmol/L) to the recurrence of endpoint event of the one year prognosis of elderly patients with the sensitivity of 88.9％ and specificity of 84.6％.Conclusion The serum level of sdLDL-C and Hcy can forecast the risk of the short-term endpoint event in elderly patients with CI.