血脂水平与急性大动脉粥样硬化型脑梗死早期神经功能恶化的关系
|
摘要
目的研究血脂水平与急性大动脉粥样硬化型脑梗死发生早期神经功能恶化(early neurological deterioration,END)的关系。方法选取2015年2月至2018年2月本院收治的217例急性大动脉粥样硬化型脑梗死患者为研究对象,根据是否发生END将其分为END组(98例)和非END组(119例)。比较两组患者治疗前后总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)及脂蛋白a[Lipoproteins,Lp(a)]等血脂水平;根据临床疗效分为愈显组(治愈+显效)、非愈显组(有效+无效),比较不同疗效患者的血脂水平。结果治疗前,END组患者TC、Lp(a)及LDL-C水平均显著高于非END组(P_均<0.001),HDL-C水平显著低于非END组(P <0.001)。治疗后,END组患者TC、Lp(a)及LDL-C水平均低于本组治疗前(P_均<0.001),HDL-C水平高于本组治疗前(P <0.001),但两组患者TC、HDL-C、Lp(a)、LDL-C水平比较差异均无显著性(P_均> 0.05)。非END组患者治疗前后各血脂指标比较差异均无显著性(P_均> 0.05)。END组患者治愈16例(16.33%),显效45例(45.92%),有效30例(30.61%),无效7例(7.14%)。愈显组患者TC、Lp(a)及LDL-C水平均显著低于非愈显组(P_均<0.05),HDL-C水平显著高于非愈显组(P <0.05)。结论 TC、Lp(a)、LDL-C及HDL-C可能作为急性大动脉粥样硬化型脑梗死发生END的预测指标,并有助于临床疗效评估。
Objective To explore the relationship between serum lipid levels and early neurological deterioration(END) in acute atherosclerotic cerebral infarction and its clinical value.Method A total of 217 patients with acute atherosclerotic cerebral infarction admitted to our hospital from February 2015 to February 2018 were enrolled.According to whether or not END,they were divided into END group(n=98) and non-END group(n=119).Before and after treatment,total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),and lipoprotein a [Lp(a)] were compared between the two groups.According to the clinical efficacy,it was divided into two groups,healing group(healing+marked effect) and non-healing group(effective+ineffective),respectively.Compared the blood lipid levels of patients with different efficacy.Result Before treatment,the levels of TC,Lp(a) and LDL-C in END group were significantly higher than those in non-END group(P_(all)<0.001),and the HDL-C level was significantly lower than that in non-END group(P<0.001).After treatment,TC,Lp(a) and LDL-C levels were lower than those before treatment(P_(all)<0.001),HDL-C level was higher than before treatment(P<0.001).There were no significant differences in TC,HDL-C,Lp(a),and LDL-C levels between END group and non-END group(P_(all)>0.05).There was no significant difference in serum lipid levels between non-END patients before and after treatment(P_(all)>0.05).In END group,16 patients(16.33%) were cured,45 patients(45.92%) were effective,30 patients(30.61%) were effective,and 7 patients(7.14%) were ineffective.The levels of TC,Lp(a) and LDL-C in healing group were lower than those in non-healing group(P_(all)<0.05),and the HDL-C level was significantly higher than that in non-healing group(P<0.05).Conclusion TC,Lp(a),LDL-C and HDL-C may be used as predictors of END in acute aortic atherosclerotic cerebral infarction and contribute to clinical efficacy evaluation.
Objective To explore the relationship between serum lipid levels and early neurological deterioration(END) in acute atherosclerotic cerebral infarction and its clinical value.Method A total of 217 patients with acute atherosclerotic cerebral infarction admitted to our hospital from February 2015 to February 2018 were enrolled.According to whether or not END,they were divided into END group(n=98) and non-END group(n=119).Before and after treatment,total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),and lipoprotein a [Lp(a)] were compared between the two groups.According to the clinical efficacy,it was divided into two groups,healing group(healing+marked effect) and non-healing group(effective+ineffective),respectively.Compared the blood lipid levels of patients with different efficacy.Result Before treatment,the levels of TC,Lp(a) and LDL-C in END group were significantly higher than those in non-END group(P_(all)<0.001),and the HDL-C level was significantly lower than that in non-END group(P<0.001).After treatment,TC,Lp(a) and LDL-C levels were lower than those before treatment(P_(all)<0.001),HDL-C level was higher than before treatment(P<0.001).There were no significant differences in TC,HDL-C,Lp(a),and LDL-C levels between END group and non-END group(P_(all)>0.05).There was no significant difference in serum lipid levels between non-END patients before and after treatment(P_(all)>0.05).In END group,16 patients(16.33%) were cured,45 patients(45.92%) were effective,30 patients(30.61%) were effective,and 7 patients(7.14%) were ineffective.The levels of TC,Lp(a) and LDL-C in healing group were lower than those in non-healing group(P_(all)<0.05),and the HDL-C level was significantly higher than that in non-healing group(P<0.05).Conclusion TC,Lp(a),LDL-C and HDL-C may be used as predictors of END in acute aortic atherosclerotic cerebral infarction and contribute to clinical efficacy evaluation.
引文
[1]黄志新,樊丽娟,杨春水,等.腔隙性脑梗死患者早期神经功能恶化相关因素分析[J].山东医药,2015,55(22):65-66.
[2]Yi X,Wang C,Liu P,et al.Antiplatelet drug resistance is associated with early neurological deterioration in acute minor ischemic stroke in the Chinese population[J].J Neurol,2016,263(8):1612-1619.
[3]李凤,朱余友,杨孙凤,等.血清五聚素3、超敏C反应蛋白、脂蛋白相关磷脂酶A2水平以及微栓子信号与大动脉粥样硬化型急性脑梗死患者颈动脉粥样硬化斑块稳定性的相关研究[J].临床神经病学杂志,2016,29(2):95-100.
[4]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[5]欧阳葵,唐湘祁.长春西汀联合依达拉奉治疗急性脑梗死的临床效果及对患者神经功能恢复的影响[J].中国医学前沿杂志(电子版),2017,9(4):52-55.
[6]Simonsen CZ,Schmitz ML,Madsen MH,et al.Early neurological deterioration after thrombolysis:Clinical and imaging predictors[J].Int J Stroke,2016,11(7):776-782.
[7]张萌,郑慧,张敏,等.颈动脉不稳定型斑块、血脂、血压与急性脑梗死关系的病例对照研究[J].中华疾病控制杂志,2016,20(8):831-834.
[8]Hu YS,Guo WY,Lee IH,et al.Prolonged cerebral circulation time is more associated with symptomatic carotid stenosis than stenosis degree or collateral circulation[J].J Neurointerv Surg,2017,10(5):476-480.
[9]崔颖,佟旭,王伊龙,等.急性缺血性卒中患者阿替普酶静脉溶栓后发生早期神经功能恶化的危险因素分析[J].中华神经科杂志,2016,49(12):925-931.
[10]马燕,吴南楠,张宁,等.2型糖尿病合并急性脑梗死患者血糖水平与急性期神经功能的相关性研究[J].中国医刊,2016,51(8):102-105.
[11]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.
[12]孙才智,邓齐文,张铮,等.甘油三酯/高密度脂蛋白胆固醇的比值在急性缺血性脑卒中预后价值的研究[J].中国急救医学,2017,37(10):923-928.
[13]黄宁芳,杨桂钦,陈强,等.瑞舒伐他汀钙治疗老年脑梗死患者合并颈动脉粥样硬化斑块的疗效及对血脂、C反应蛋白水平的影响[J].中国老年学杂志,2017,37(6):1382-1383.
[14]Nave AH,Lange KS,Leonards CO,et al.Lipoprotein(a)as a risk factor for ischemic stroke:a meta-analysis[J].Atherosclerosis,2015,242(2):496-503.
[15]Yu B,Khan K,Hamid Q,et al.Pathological significance of lipoprotein(a)in aortic valve stenosis[J].Atherosclerosis,2018,272:168-174.
[16]Cao J,Steffen BT,Guan W,et al.Evaluation of Lipoprotein(a)Electrophoretic and Immunoassay Methods in Discriminating Risk of Calcific Aortic Valve Disease and Incident Coronary Heart Disease:The Multi-Ethnic Study of Atherosclerosis[J].Clin Chem,2017,63(11):1705-1713.
[17]Ryu WS,Schellingerhout D,Jeong SW,et al.Association between Serum Lipid Profiles and Early Neurological Deterioration in Acute Ischemic Stroke[J].J Stroke Cerebrovasc Dis,2016,25(8):2024-2030.
[18]吴兆华.颈动脉粥样硬化斑块与老年急性脑梗死的关系及其相关危险因素分析[J].中国医学前沿杂志(电子版),2014,6(12):117-120.
[19]Lee SJ,Lee DG.Distribution of atherosclerotic stenosis determining early neurologic deterioration in acute ischemic stroke[J].PLo S One,2017,12(9):e0185314.
[2]Yi X,Wang C,Liu P,et al.Antiplatelet drug resistance is associated with early neurological deterioration in acute minor ischemic stroke in the Chinese population[J].J Neurol,2016,263(8):1612-1619.
[3]李凤,朱余友,杨孙凤,等.血清五聚素3、超敏C反应蛋白、脂蛋白相关磷脂酶A2水平以及微栓子信号与大动脉粥样硬化型急性脑梗死患者颈动脉粥样硬化斑块稳定性的相关研究[J].临床神经病学杂志,2016,29(2):95-100.
[4]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[5]欧阳葵,唐湘祁.长春西汀联合依达拉奉治疗急性脑梗死的临床效果及对患者神经功能恢复的影响[J].中国医学前沿杂志(电子版),2017,9(4):52-55.
[6]Simonsen CZ,Schmitz ML,Madsen MH,et al.Early neurological deterioration after thrombolysis:Clinical and imaging predictors[J].Int J Stroke,2016,11(7):776-782.
[7]张萌,郑慧,张敏,等.颈动脉不稳定型斑块、血脂、血压与急性脑梗死关系的病例对照研究[J].中华疾病控制杂志,2016,20(8):831-834.
[8]Hu YS,Guo WY,Lee IH,et al.Prolonged cerebral circulation time is more associated with symptomatic carotid stenosis than stenosis degree or collateral circulation[J].J Neurointerv Surg,2017,10(5):476-480.
[9]崔颖,佟旭,王伊龙,等.急性缺血性卒中患者阿替普酶静脉溶栓后发生早期神经功能恶化的危险因素分析[J].中华神经科杂志,2016,49(12):925-931.
[10]马燕,吴南楠,张宁,等.2型糖尿病合并急性脑梗死患者血糖水平与急性期神经功能的相关性研究[J].中国医刊,2016,51(8):102-105.
[11]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.
[12]孙才智,邓齐文,张铮,等.甘油三酯/高密度脂蛋白胆固醇的比值在急性缺血性脑卒中预后价值的研究[J].中国急救医学,2017,37(10):923-928.
[13]黄宁芳,杨桂钦,陈强,等.瑞舒伐他汀钙治疗老年脑梗死患者合并颈动脉粥样硬化斑块的疗效及对血脂、C反应蛋白水平的影响[J].中国老年学杂志,2017,37(6):1382-1383.
[14]Nave AH,Lange KS,Leonards CO,et al.Lipoprotein(a)as a risk factor for ischemic stroke:a meta-analysis[J].Atherosclerosis,2015,242(2):496-503.
[15]Yu B,Khan K,Hamid Q,et al.Pathological significance of lipoprotein(a)in aortic valve stenosis[J].Atherosclerosis,2018,272:168-174.
[16]Cao J,Steffen BT,Guan W,et al.Evaluation of Lipoprotein(a)Electrophoretic and Immunoassay Methods in Discriminating Risk of Calcific Aortic Valve Disease and Incident Coronary Heart Disease:The Multi-Ethnic Study of Atherosclerosis[J].Clin Chem,2017,63(11):1705-1713.
[17]Ryu WS,Schellingerhout D,Jeong SW,et al.Association between Serum Lipid Profiles and Early Neurological Deterioration in Acute Ischemic Stroke[J].J Stroke Cerebrovasc Dis,2016,25(8):2024-2030.
[18]吴兆华.颈动脉粥样硬化斑块与老年急性脑梗死的关系及其相关危险因素分析[J].中国医学前沿杂志(电子版),2014,6(12):117-120.
[19]Lee SJ,Lee DG.Distribution of atherosclerotic stenosis determining early neurologic deterioration in acute ischemic stroke[J].PLo S One,2017,12(9):e0185314.