摘要
目的:探讨在不同的LDL-C水平,血脂相关剩余风险与大动脉粥样硬化性脑卒中(large artery atherosclerotic,LAA)的相关性。方法:前瞻性、多中心的中国国家卒中登记研究(China National Stroke Registry,CNSR)数据库中入选的3 492例LAA脑卒中患者,与3 022例非大动脉粥样硬化非小血管闭塞性(non large artery atherosclerosis&small vessel occlusion,Non LAA&SAO)脑卒中患者作为研究人群,多因素logistic回归分析在不同LDL-C水平,血脂相关剩余风险与LAA脑卒中的关系。结果:在LDL-C≥2.59mml/L,低HDL-C与LAA脑卒中风险增加相关(OR=1.20,P=0.027)。高TG、高nonHDL-C、高TG并低HDL-C均与LAA脑卒中发生不相关。在LDL-C<2.59mmol/L,HDL-C每增加1mmol/L,LAA脑卒中发生的相对风险下降45%(OR=0.55,P<0.0001)。HDL-C最低三分位(<1.04)组与最高三分位(≥1.33)组比较,低HDL-C与LAA脑卒中风险比率增加相关(OR=1.64,P=0.03)。non-HDL-C每增加1mmol/L,LAA脑卒中发生的风险比率增加79%(OR=1.79,P<0.0001)。non-HDLC最高三分位(≥2.96)组与最低三分位(<2.46)组比较,高non-HDL-C与LAA脑卒中风险增加正相关(OR=1.5,P<0.001)。TG水平最低三分位组(<0.97)与最高三分位组(≥1.59)比较,高TG水平与LAA脑卒中风险增加正相关(OR=1.38,P<0.001)。TG/HDL-C比值每增加1个单位,LAA脑卒中相对风险增加12%[OR=1.12,P=0.002]。TG/HDL-C比值最高三分位与最低三分位比较,TG/HDL-C比值升高与LAA脑卒中风险增加独立相关(OR=1.30,P<0.0001)。结论:HDL-C水平降低是LAA脑卒中风险增加的独立危险因素,独立于LDL-C水平。在LDL-C达到<2.59mmol/L,高TG、高non-HDLC、高TG并低HDL-C是LAA脑卒中的血脂相关剩余风险。
Objective：Recent studies suggest that low levels of HDL-C and high levels of TG are lipidrelated residual risks of cardiovascular diseases.This study was conducted to prospectively assess the association of lipid-related residual risks with large artery atherosclerotic （LAA） stroke at different LDL-C levels in the hospitalized patients with LAA stroke.Methods：This study enrolled 3 492 LAA stroke patients and 3 022 non LAA＆SAO stroke patients from the China National Stroke Registry （CNSR） Project.Demographic,vascular risks and clinical data were collected at admission.Independent associations of lipid-related residual risks with LAA stroke were evaluated under different LDL-C strata.Results：After adjusting for other risk factors,LAA stroke was independently associated with low HDL-C [OR 1.20,P =0.027] among patients with LDL-C ≥2.59mmol/L,while LAA stroke was not associated with high TG,high non-HDL-C and high TG/HDL-C ratio.Among patients with LDL-C ＜ 2.59mmol/L,LAA stroke was independently associated with HDL-C （OR per 1 mmol/L increase：0.55,P ＜ 0.0001） ; OR for lowest vs.highest lipid tertiles：1.64,P =0.03）,non HDL-C [（OR per 1 mmol/L increase：1.79,P ＜ 0.0001 ; OR for lowest vs.highest lipid tertiles：1.50,P ＜ 0.001],TG（OR for lowest vs.highest lipid tertiles：1.38,P ＜0.001）and TG/HDL-C ratio[（OR per 1 unit increase：1.12,P =0.002 ; OR for highest vs.lowest lipid tertiles：1.30,P ＜ 0.0001].Conclusion：Low HDL-C at admission was associated with LAA stroke independent of LDL-C levels.HighTG,high non-HDL-C,high TG and low HDL-C dyslipidemia were positively correlated with LAA stroke only among study subjects with LDL-C ＜ 2.59 mmol/L.Low HDL-C,highTG,high non-HDL-C,high TG and low HDL-C dyslipidemia were lipid-related residual risks for LAA stroke.
出处
《心肺血管病杂志》
CAS
2014年第4期496-502,共7页
Journal of Cardiovascular and Pulmonary Diseases
