血脂指标的比值在预测心脑疾病患者颈动脉内-中膜增厚中的作用

摘要

Objective To evaluate the correlations between carotid intima-media thickness (CJMT) and blood lipids (including lipids, lipoproteins and apolipoproteins) , high sensitivity C-reactive protein (hs-CRP), fasting glucose, age, and sex et al. Methods The clinical data of 833 patients aged ≥ 40 years of age in the Departments of Neurology and Cardiology, the Affiliated Dongguan Hospital, School of Medicine, Jinan University from September 2009 to March 2010 were analyzed retrospectively, including ultrasound-derived mean CIMT, age, sex,the levels of serum lipids(including lipids, lipoprotein, apoli-poprotein, and lipids ratio, such as LDL-C/HDL-C, total cholesterol/HDL-C, apolipoprotein B/apoli-poprotein Al ratio), hs-CRP, fasting glucose. The patients were divided into either a normal group (the mean CIMT < 1.0 mm,n = 172) or a thickening group (the mean CIMT ≥1.0 mm,n =661) according to their CIMT. A binary logistic regression analysis was use to identify the independent risk factors for increased CIMT. Results ①The median of age, fasting glucose, hs-CRP, low-density lipoprotein cholesterol/high density lipoprotein cholesterol (LDL-C/HDL-C) ratio, total cholesterol (TC)/HDL-C ratio, and apolipoprotein B/apolipoprotein A-I ratio in the thickening group were significantly higher than those in the normal group, and the median of HDL-C and apolipoprotein A-I were lower than those in the normal group. The number of men in the thickening group was obviously more than that in the normal group. There was significant differences (all P < 0.05). There were no significant differences in other variables between the 2 groups. ②Binary logistic regression analysis showed that significant risk factors associated with increased CIMT were age (OR, 1.085, 95% CI 1.067 - 1. 104), man (OR, 1.897, 95% CI 1.985-2.799), hs-CRP(OR, 1.165, 95%CI 1.047 - 1. 296), and LDL-C/HDL-C ratio (OR, 1.281, 95% Cl 1.040-1.579). Conclusion The age, male, hs-CRP, and LDL-C/HDL-C ratio were the independent risk factors for increased CIMT. LDL-C/HDL-C in the prediction of increased CIMT may be superior to the separate detection of LDL-C or HDL-C.%目的 评价颈动脉内-中膜厚度(CIMT)与血脂(包括脂质、脂蛋白、载脂蛋白)、超敏C反应蛋白(hs-CRP)、空腹血糖、年龄、性别等因素间的相关性. 方法 回顾性分析2009年9月-2010年3月在广州市红十字会医院神经内科和心内科住院,年龄≥40岁的833例患者的临床资料,包括采用超声测量的平均CIMT、性别、年龄、血脂水平[脂质、脂蛋白、载脂蛋白,以及脂质比值,包括低密度脂蛋白胆固醇( LDL-C)与高密度脂蛋白胆固醇(HDL-C)的比值、载脂蛋白B(Apo-B)与载脂蛋白A-Ⅰ(ApoA-Ⅰ)的比值及总胆固醇(TC)与HDL-C的比值]、hs-CRP、空腹血糖等资料.依据患者的CIMT,分为正常组(平均CIMT＜ 1.0 mm)172例,增厚组(平均CIMT≥1.0mm)661例.采用二元Logistic回归分析筛选出CIMT增厚的独立危险因素. 结果 ①增厚组患者的年龄、空腹血糖、hs-CRP、LDL-C/HDL-C比值、TC./HDL-C比值、Apo-B/ApoA-Ⅰ比值的中位数,均高于正常组,而HDL-C、ApoA-Ⅰ的中位数低于正常组.增厚组男性例数要明显多于正常组,差异有统计学意义,均P＜0.05.两组之间其他变量差异无统计学意义.②二元Logistic回归显示,年龄(OR=1.085,95％ CI:1.067～1.104)、男性(OR=1.897,95％ CI:1.985 -2.799)、hs-CRP(OR=1.165,95％ CI:1.047-1.296)、LDL-C/HDL-C比值(OR=1.281,95％ CI:1.040～1.579)是预测CIMT增厚的独立危险因素. 结论 LDL-C/HDL-C比值增高是预测心脑疾病患者CIMT增厚的独立危险因素,其预测作用可能要优于单独检测LDL-C或HDL-C.