Zhongguo cuzhong zazhi (Aug 2022)
高海拔地区缺血性卒中患者单核 细胞/HDL-C比值与脑动脉粥样硬化性狭窄的相关性 LEI Yancheng, LIU Zhu, WANG Jinpeng, ZHANG Hao, YANG Wenfang, XIAO Shunxi, YANG Huijie, MO Haizhen, CHEN Yan
Abstract
目的 研究高海拔地区缺血性卒中患者单核细胞/HDL-C比值（monocyte/HDL-C ratio，MHR）与颅内动脉粥样硬化性狭窄（intracranial atherosclerotic stenosis，ICSA）程度的相关性。 方法 回顾性连续纳入2017年6月-2021年6月在青海省人民医院住院治疗的高海拔地区（海拔2260～4080 m）的急性缺血性卒中患者，依据DSA上脑血管狭窄程度（以狭窄最严重的动脉为准）分为无狭窄组、轻度狭窄（狭窄率≤50%）组、中度狭窄（狭窄率50%～70%）组、重度狭窄（狭窄率≥70%）组及闭塞（100%）组。比较5组患者的临床资料、实验室检查指标和MHR，并采用logistic回归模型计算不同程度血管狭窄的独立危险因素。 结果 共纳入349例患者，其中无狭窄组69例、轻度狭窄组78例、中度狭窄组41例、重度狭窄组84例、闭塞组77例。5组中年龄、性别分布、吸烟、饮酒、高血压、糖尿病比例方面差异均有统计学意义，实验室检查中白细胞、单核细胞、中性粒细胞、血小板计数以及血红蛋白、HDL-C水平和MHR差异也有统计学意义。多因素logistic回归分析显示，相对于无动脉狭窄，高龄为脑血管轻度狭窄（OR 1.061，95%CI 1.027～1.097，P＜0.001），中度狭窄（OR 1.057，95%CI 1.017～1.099，P＝0.005），重度狭窄（OR 1.096，95%CI 1.057～1.137，P＜0.001），闭塞（OR 1.036，95%CI 1.001～1.072，P＝0.046）的独立危险因素；相对于无动脉狭窄，高MHR为轻度狭窄（OR 1.041，95%CI 1.009～1.074，P＝0.011），中度狭窄（OR 1.082，95%CI 1.045～1.119，P＜0.001），重度狭窄（OR 1.096，95%CI 1.062～1.131，P＜0.001），闭塞（OR 1.101，95%CI 1.067～1.136，P＜0.001）的独立危险因素；相对于无动脉狭窄，单核细胞计数升高是中度狭窄（OR 1.684，95%CI 1.569～2.725，P=0.027）、重度狭窄（OR 3.529，95%CI 1.541～5.766，P=0.002 ）和闭塞（OR 5.446，95%CI 4.453～6.917，P=0.002）的独立危险因素。 结论 高龄、高MHR和单核细胞计数升高在高海拔地区对急性缺血性卒中患者的脑动脉粥样硬化性狭窄程度具有一定预测价值。 Abstract: Objective To study the correlation between the monocyte/high density lipoprotein cholesterol ratio (MHR) and the degree of intracranial atherosclerotic stenosis (ICAS) in high altitude area. Methods Patients with acute cerebral infarction in high altitude area (2260-4480 m) in Qinghai People's Hospital from June 2017 to June 2021 were included in this retrospective study. According to the degree of cerebral artery stenosis on DSA imaging, all the patients were divided into 5 groups: no stenosis group, mild stenosis group (≤50%), moderate stenosis group (50%-70%), severe stenosis group (≥70%) and occlusion group (100%). The baseline clinical data, laboratory tests results and MHR were collected. Logistic regression model was used to analyze the risk factors for cerebral artery stenosis. Results A total of 349 patients were included. There were 69 patients without stenosis, 78 patients with mild stenosis, 41 patients with moderate stenosis, 84 patients with severe stenosis and 77 patients with occlusion. Multivariate logistic regression analysis showed that old age and high MHR were independent risk factors for mild stenosis (OR 1.061, 95%CI 1.027-1.097, P<0.001; OR 1.041, 95%CI 1.009-1.074, P=0.011), moderate stenosis (OR 1.057, 95%CI 1.017-1.099, P=0.005; OR 1.082, 95%CI 1.045-1.119, P<0.001), severe stenosis (OR 1.096, 95%CI 1.057-1.137, P<0.001; OR 1.096, 95%CI 1.062-1.131, P<0.001) and occlusion (OR 1.036, 95%CI 1.001-1.072, P=0.046; OR 1.101, 95%CI 1.067-1.136, P<0.001), compared to no stenosis; increased monocyte count was an independent risk factor for moderate stenosis (OR 1.684, 95%CI 1.569-2.725, P=0.027), severe stenosis (OR 3.529, 95%CI 1.541-5.766, P=0.002) and occlusion (OR 5.446, 95%CI 4.453-6.917, P=0.002). Conclusions Old age, high MHR and increased monocyte count were associated with intracranial atherosclerotic stenosis in patients with acute cerebral infarction in high altitude area.
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