[1]张瑶,杨晓丽,王敏佳,等.非传统脂质参数对急性缺血性脑卒中静脉溶栓后早期功能恶化的预测研究[J].卒中与神经疾病杂志,2025,32(02):184-189.[doi:10.3969/j.issn.1007-0478.2025.02.013]
点击复制

非传统脂质参数对急性缺血性脑卒中静脉溶栓后早期功能恶化的预测研究()
分享到:

《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第32卷
期数:
2025年02期
页码:
184-189
栏目:
论著
出版日期:
2025-04-20

文章信息/Info

文章编号:
1007-0478(2025)02-0184-06
作者:
张瑶杨晓丽王敏佳高新丽程树斌王友明
056002 邯郸,河北工程大学附属医院神经病学中心[张瑶 杨晓丽 王敏佳 高新丽 程树斌 王友明(通信作者)]
关键词:
非传统脂质参数 非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇的比值 急性缺血性脑卒中 静脉溶栓 早期神经功能恶化
分类号:
R743.3
DOI:
10.3969/j.issn.1007-0478.2025.02.013
文献标志码:
A
摘要:
目的 探讨非传统脂质参数非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇的比值(Non-high-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio,non-HDL-C/HDL-C)与急性缺血性脑卒中患者应用重组组织型纤溶酶原激活剂静脉溶栓治疗后出现早期神经功能恶化(Early neurological deterioration,END)的关系。方法 选取2022年3月-2024年2月在河北工程大学附属医院收治的接受重组组织型纤溶酶原激活剂静脉溶栓的急性缺血性脑卒中患者186例进行回顾性分析,END定义为静脉溶栓后24 h内NIHSS(National institute of health stroke scale,NIHSS)评分总分增加≥4分或死亡,将其分为非END组(143例)和END组(43例),比较2组基线人口学信息、既往病史以及血糖、血脂等生化检测指标水平; 采用受试者工作特征(Receiver operating characteristic,ROC)曲线和二元Logistic回归分析研究上述因素与END之间的关系,并纳入随机森林模型分析各指标权重比例。结果 单变量分析显示,非END组和END组在脑卒中史、总胆固醇、低密度胆固醇、non-HDL-C水平、non-HDL-C/HDL-C、入院收缩压均有明显差异(P<0.05); 纳入Logistic回归模型显示,non-HDL-C/HDL-C(OR=1.913,95%CI=1.210~3.026,P=0.006),入院收缩压(OR=1.017,95%CI=1.001~1.033,P=0.039)对END产生显著的正向影响关系,脑卒中史(OR=0.253,95%CI=0.090~0.712,P=0.009)对END产生负向影响关系; 联合诊断的ROC曲线显示,曲线下面积(Area under the curve,AUC)为0.709,最佳界值0.337,敏感度0.512,特异度0.825,Cut-off值0.306; 随机森林模型显示,三者在模型构建中权重比例分别为53.26、42.08和4.66%。结论 非传统脂质参数non-HDL-C/HDL-C可能是新型的预测缺血性脑卒中静脉溶栓后END发生的可靠生物标记物。

参考文献/References:

[1] Sun J,Qiao Y,Zhao M,et al.Regional,and national burden of cardiovascular diseases in youths and young adults aged 15-39 years in 204 countries/territories,1990-2019:a systematic analysis of global burden of disease study 2019[J].BMC Med,2023,21(1):222.
[2] Hacke WK,Ecass I.Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke[J].N Engl J Med,2008,359(13):1317-1329.
[3] Luo YH,Peng DQ.Residual atherosclerotic cardiovascular disease risk: focus on non-high-density lipoprotein cholesterol[J].J Cardiovasc Pharmacol Ther,2023,28:10742484231189597.
[4] Toprak K,Kaplangoray M,Akyol S,et al.The non-HDL-C/HDL-C ratio is a strong and Independent predictor of the no-reflow phenomenon in patients with ST-elevation myocardial infarction[J].Acta Cardiol,2024,79(2):194-205.
[5] Zhao Z,Wang HR,Hou Q,et al.Non-traditional lipid parameters as potential predictors of carotid plaque vulnerability and stenosis in patients with acute ischemic stroke[J].Neurol Sci,2023,44(3):835-843.
[6] Yu WM,Abdul-Rahim AH,Cameron AC,et al.The incidence and associated factors of early neurological deterioration after thrombolysis: results from SITS registry[J].Stroke,2020,51(9):2705-2714.
[7] Kim JM,Moon J,Ahn SW,et al.The etiologies of early neurological deterioration after thrombolysis and risk factors of ischemia progression[J].J Stroke Cerebrovasc Dis,2016,25(2):383-388.
[8] Tschirret O,Moreno Legast G,Mansuy A,et al.Impact of brain atrophy on early neurological deterioration and outcome in severe ischemic stroke treated by intravenous thrombolysis[J].Eur Neurol,2018,79(5/6):240-246.
[9] Zhou HM,Zhang SZ,Sun XT,et al.Lipid management for coronary heart disease patients: an appraisal of updated international guidelines applying appraisal of guidelines for research and evaluation II-clinical practice guideline appraisal for lipid management in coronary heart disease[J].J Thorac Dis,2019,11(8):3534-3546.
[10] Heidemann BE,Koopal C,Roeters van Lennep JE,et al.Effect of evolocumab on fasting and post fat load lipids and lipoproteins in familial dysbetalipoproteinemia[J].J Clin Lipidol,2023,17(1):112-123.
[11] Ballantyne CM,Ditmarsch M,Kastelein JJ,et al.Obicetrapib plus ezetimibe as an adjunct to high-intensity statin therapy:a randomized phase 2 trial[J].J Clin Lipidol,2023,17(4):491-503.
[12] Sung SM,Kang YJ,Cho HJ,et al.Prediction of early neurological deterioration in acute minor ischemic stroke by machine learning algorithms[J].Clin Neurol Neurosurg,2020,195:105892.
[13] Guo JH,Wang AX,Wang Y,et al.Non-traditional lipid parameters as potential predictors of asymptomatic intracranial arterial stenosis[J].Front Neurol,2021,12:679415.
[14] Liu Y,Zhang ZW,Xia BL,et al.Relationship between the non-HDLc-to-HDLc ratio and carotid plaques in a high stroke risk population:a cross-sectional study in China[J].Lipids Health Dis,2020,19(1):168.
[15] Wang LB,Han Y,Cao CC,et al.The non-linear Link between non-high-density lipoprotein to high-density lipoprotein ratio and the risk of stroke in middle-aged and older adults in Chinese:a prospective cohort study from the China health and retirement longitudinal study[J].Front Endocrinol(Lausanne),2023,14:1303336.
[16] Han Q,You SJ,Maeda T,et al.Predictors of early versus delayed neurological deterioration after thrombolysis for ischemic stroke[J].Cerebrovasc Dis,2024:1-9.
[17] Barow E,Boutitie F,Cheng B,et al.24-hour blood pressure variability and treatment effect of intravenous alteplase in acute ischaemic stroke[J].Eur Stroke J,2021,6(2):168-175.
[18] Liu LP,Zhou HY,Duan WY,et al.Chinese stroke association guidelines for clinical management of cerebrovascular diseases(second edition)(excerpt)--chapter four clinical management of ischaemic cerebrovascular diseases[J].Journal volume&,2023,18(8):1673-5765.
[19] Chung JW,Kim N,Kang J,et al.Blood pressure variability and the development of early neurological deterioration following acute ischemic stroke[J].J Hypertens,2015,33(10):2099-2106.

备注/Memo

备注/Memo:
基金项目:邯郸市科学技术研究与发展计划项目(22422083082ZC)
更新日期/Last Update: 2025-04-20