本文選題：缺血性卒中高 + 密度脂蛋白膽固醇�。� 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:生理狀態(tài)下的高密度脂蛋白膽固醇(high density lipoprotein cholesterol,HDL-C)在體內(nèi)發(fā)揮逆向轉(zhuǎn)運膽固醇、抗炎及抗氧化作用;而在炎癥和代謝異常等病理狀態(tài)下,HDL-C經(jīng)過氧化、糖基化或酪氨�；刃揎椬饔�,使HDL-C的結(jié)構(gòu)、組成成分發(fā)生改變,并誘發(fā)低HDL-C血癥產(chǎn)生。從而表現(xiàn)出促炎、促氧化等特性,成為動脈粥樣硬化(Atherosclerosis,AS)發(fā)生、發(fā)展的危險因素。故低HDL-C血癥作為國人脂代謝異常的最常見形式,應(yīng)為缺血性卒中的危險因素,與卒中的發(fā)生、復(fù)發(fā)以及卒中急性期病情嚴重程度的密切相關(guān)。由此,關(guān)注低HDL-C血癥,探討低HDL-C血癥的危險因素至關(guān)重要�；诖�,本研究以缺血性卒中患者為研究對象,分析缺血性卒中患者低HDL-C血癥的患病率,探討缺血性卒中患者低HDL-C血癥的相關(guān)危險因素。方法:1研究對象:以2006年12月至2012年12月入住河北醫(yī)科大學(xué)附屬第三醫(yī)院神經(jīng)內(nèi)科,依據(jù)改良版TOAST卒中病因分型的診斷標準,將明確診斷為大動脈粥樣硬化(large artery atherosclerosis,LAA)及小血管病變(Small artery disease,SAD)的患者作為研究對象,且所有入組患者均具有標準的人口構(gòu)成情況及血管病危險因素登記。并排除心源性栓塞、其他原因及未明原因的缺血性卒中患者;患有嚴重肝、腎功能受損及臨床資料不全者。2低高密度脂蛋白膽固醇血癥的診斷標準:依據(jù)美國ATPIII標準,低HDL-C血癥定義為:HDL-C≤1.03mmol/L;孤立低HDL-C血癥:定義為HDL-C≤1.03mmol/L,且甘油三酯(triglycerides,TG)1.7mmol/L+低密度脂蛋白膽固醇(low-densitylipoprotein cholesterol,LDL-C)2.59mmol/L。其他各成分脂代謝紊亂定義為:總膽固醇(tatal cholesterol,TC≥5.18mmol/L和(或)TG≥1.7mmol/L和(或)LDL-C≥2.59mmol/L。3統(tǒng)計學(xué)方法:采用SPSS13.0軟件進行統(tǒng)計學(xué)分析。以低HDL-C血癥組患者作為因變量,各血管病危險因素如高血壓、糖尿病、吸煙、飲酒等因素作為自變量,依次應(yīng)用單因素及多因素Logistic回歸分析,評估低HDL-C血癥與各血管病危險因素的相關(guān)性。P0.05判定為差異有統(tǒng)計學(xué)意義。結(jié)果:1滿足入選標準的缺血性卒中患者1358例,男性897例,女性461例,診斷為LAA患者795例,SAD患者562例。所有入組患者低HDL-C血癥的患病率為64.2%,其中男性60.8%,女性39.2%,差別有顯著性意義(χ2=29.074,P0.01);LAA組患者低HDL-C血癥的患病率為61.0%,明顯高于SAD組患者(39.0%),差異具有統(tǒng)計學(xué)意義(χ2=5.674,P0.01)。本研究入組患者中僅有HDL-C水平降低,而低密度脂蛋白和甘油三酯水平均正常的孤立低HDL-C血癥的患病率為31.8%,成為亞洲人群常見的脂質(zhì)表型。本研究說明缺血性卒中患者低HDL-C血癥的發(fā)生率較高,尤其更常見于男性及LAA患者。2缺血性卒中患者發(fā)生低HDL-C血癥的危險因素以低HDL-C血癥為因變量,各血管病危險因素為自變量,經(jīng)遞次單因素、多因素logistic回歸分析顯示:增加低HDL-C血癥發(fā)病風(fēng)險的獨立危險因素依次為:男性、高TG血癥、糖尿病和他汀使用史(OR值分別為3.318、2.529、1.652、1.457;P值均0.05)。而年齡(P=1.131)、吸煙(P=0.471)、飲酒(P=0.101)、高血壓(P=0.657)、卒中史(P=0.552)、冠心病史(P=0.937)、高LDL-C(P=0.075)與低HDL-C血癥發(fā)生無顯著相關(guān)性。TC與HDL-C水平呈正相關(guān)(OR=0.400,95%CI0.301-0.530,P=0.000)。高TC血癥的存在往往伴有高HDL-C,說明兩者之間存在互為轉(zhuǎn)換的關(guān)系。對不同性別缺血性卒中患者低HDL-C血癥的危險因素進行分析,結(jié)果顯示:男性缺血性卒中患者組低HDL-C血癥的獨立危險因素依次是高TG、他汀類藥物、糖尿病、吸煙、飲酒(OR值分別為2.384、1.715、1.535、1.475、1.455;P值均0.05);而女性組低HDL-C血癥的獨立危險因素僅有高TG和糖尿病(OR值分別為2.780、1.910;P值均0.05)。說明女性性別是低HDL-C的保護性因素,可能與雌激素具有增加成熟HDL2的含量的作用有關(guān)。而吸煙、飲酒史為男性缺血性卒中患者低HDL-C血癥的獨立危險因素,說明吸煙、飲酒等不良生活習(xí)慣可以誘發(fā)低HDL-C血癥的產(chǎn)生,從而誘發(fā)動脈粥樣硬化以及卒中的發(fā)生。對不同卒中亞型的缺血性卒中患者低HDL-C血癥的危險因素進行分析發(fā)現(xiàn):男性、高TG及糖尿病同樣為不同亞型缺血性卒中患者低HDL-C血癥的獨立危險因素;而他汀使用史僅與SAD患者的低HDL-C血癥密切相關(guān)(OR值=2.0202,P=0.002)。說明高TG血癥同樣為亞洲人群常見的脂代謝異常類型,而高TG血癥可通過多種機制導(dǎo)致HDL-C水平減低:高TG血癥可使卵磷脂膽固醇酰基轉(zhuǎn)移酶(LCAT)、脂蛋白酯酶(LPL)活性減弱,從而使HDL-C成熟代謝受阻;而且高TG血癥患者的膽固醇酯轉(zhuǎn)移蛋白(CETP)活性增強,使HDL-C所運輸?shù)哪懝檀济撌?導(dǎo)致HDL-C重構(gòu),血中HDL-C含量降低。而糖尿病作為低HDL-C血癥的獨立危險因素,不僅與高血糖情況下,HDL-C中的蛋白質(zhì)發(fā)生直接糖基化修飾,使HDL-C水平降低有關(guān),而且糖尿病時,胰島素抵抗、糖利用障礙,一方面可促進脂肪分解和炎性反應(yīng)使HDL-C水平的降低;另一方面通過促進TG分泌增加而發(fā)生高TG血癥,進一步加劇HDL-C水平的降低。故臨床上需積極控制患者血管病危險因素,尤其對于糖尿病合并高TG血癥者更需早期干預(yù)。因本研究作為回顧性研究,所入選患者服用他汀藥物的種類和期限各不相同,且不同他汀類藥物作用不盡相同,故不能肯定他汀類藥物應(yīng)用史為低HDL-C血癥的危險因素。3對孤立低HDL-C血癥進行相關(guān)危險因素分析顯示:男性、糖尿病及他汀使用史是孤立的低HDL-C血癥發(fā)病風(fēng)險的獨立危險因素(OR值分別為2.557、1.754、2.152;P值分別為0.000、0.017、0.002)。說明孤立低HDL-C血癥的危險因素、臨床意義均等同于低HDL-C血癥,其作為缺血性卒中的危險因素應(yīng)予以重視。結(jié)論:本研究入組的缺血性卒中患者低HDL-C血癥的患病率高達64.2%,尤其多見于LAA患者;男性、高甘油三酯血癥及糖尿病為缺血性卒中患者低HDL-C血癥的危險因素;而吸煙、飲酒史為男性缺血性卒中患者低HDL-C血癥的獨立危險因素。
[Abstract]:Objective: high density lipoprotein cholesterol (HDL-C) plays the role of reverse transport of cholesterol, anti-inflammatory and antioxidation in the body. In the pathological state of inflammation and metabolism, HDL-C has been modified by oxidation, glycosylation or tyemonylation to make the structure and composition of HDL-C occur. Change, and induce the production of hypoxemia, which shows the characteristics of proinflammatory and oxidation, which is the risk factor for the occurrence and development of atherosclerosis (Atherosclerosis, AS). Therefore, low HDL-C is the most common form of abnormal lipid metabolism in the country, which should be the risk factor of ischemic stroke, the occurrence of stroke, the recurrence, and the acute stage of stroke. It is closely related to the severity of the disease. Therefore, it is very important to pay attention to the hypotoxemia of HDL-C and to explore the risk factors of low HDL-C. Based on this, the incidence of hypoemia in ischemic stroke patients and the related risk factors of low HDL-C in ischemic stroke patients are analyzed in this study. Methods: 1 Research on the risk factors of hypoemia in ischemic stroke patients. Subjects: in the neurology department of the Third Affiliated Hospital of Hebei Medical University from December 2006 to December 2012, according to the diagnostic criteria of the modified TOAST apoplexy, the patients were diagnosed as large artery atherosclerosis (LAA) and small vascular disease (Small artery disease, SAD). All patients with a standard population composition and risk factors for vascular disease were registered. Cardiac embolism, other causes, and unexplained ischemic stroke patients; the diagnostic criteria for.2 low density lipoprotein cholesterol in patients with severe liver, renal impairment and clinical data were low, according to the American ATPIII standard. HDL-C is defined as HDL-C < 1.03mmol/L; isolated low HDL-C: HDL-C < 1.03mmol/L, and triglyceride (triglycerides, TG) 1.7mmol/L+ low density lipoprotein cholesterol (Low-densitylipoprotein cholesterol, LDL-C) is defined as total cholesterol. Statistical analysis of (or) TG > 1.7mmol/L and / or LDL-C > 2.59mmol/L.3: using SPSS13.0 software for statistical analysis. The risk factors of vascular disease, such as hypertension, diabetes, smoking, drinking and other factors as independent variables, were used as the dependent variable in the low HDL-C group, and the single factor and multiple factor Logistic regression analysis were used in order to evaluate the low H. The correlation between DL-C and the risk factors of vascular disease was statistically significant. Results: 1 the 1358 cases of ischemic stroke, 897 cases of male, 461 women, 795 cases of LAA and 562 cases of SAD were found to meet the criteria of admission. The prevalence rate of low HDL-C in all the patients was 64.2%, including 60.8% of men and 39.2% in women. The difference was significant (x 2=29.074, P0.01); the prevalence rate of hypoxemia in group LAA was 61%, significantly higher than that in group SAD (39%), and the difference was statistically significant (x 2=5.674, P0.01). In this study group, only HDL-C level decreased, and low density lipoprotein and triglyceride levels were all normal isolated and low HDL-C. The rate of 31.8% is a common lipid phenotype in Asian people. This study shows that the incidence of hypoxemia in patients with ischemic stroke is higher, especially in men and LAA patients with.2 ischemic stroke. The risk factors of hypoemia in.2 ischemic stroke are low HDL-C as the dependent variable, the risk factors of each vascular disease are independent variables, and the single cause of the recurrence of blood vessel disease is a single cause. Multivariate logistic regression analysis showed that the independent risk factors for increasing the risk of hypotheemia were: men, high TG, diabetes and statin use (OR values were 3.318,2.529,1.652,1.457, P, respectively 0.05). Age (P=1.131), smoking (P= 0.471), alcohol (P=0.101), hypertension (P=0.657), stroke history (P=0.552), coronary heart disease, coronary heart disease There was no significant correlation between high LDL-C (P=0.075) and hypoxemia,.TC was positively correlated with HDL-C levels (OR=0.400,95%CI0.301-0.530, P=0.000). The presence of high TC was often accompanied by high HDL-C, indicating the existence of mutual conversion between them. The risk factors for low HDL-C hyperemia in patients with different ischemic stroke were divided. The results showed that the independent risk factors of hypoxemia in male patients with ischemic stroke were high TG, statins, diabetes, smoking, drinking (OR value was 2.384,1.715,1.535,1.475,1.455, P value, respectively 0.05), while the independent risk factors of low HDL-C in female group were only high TG and diabetes (OR value was 2.780,1.910; P value was 0). .05). It shows that female sex is a protective factor of low HDL-C and may be associated with the role of estrogen in increasing the content of mature HDL2. Smoking and drinking history are independent risk factors for low HDL-C in male patients with ischemic stroke, indicating that smoking, drinking and other unhealthy habits can induce the production of low HDL-C, thus inducing the arteries. The risk factors of hypoxemia in patients with different stroke ischemic stroke were analyzed. The risk factors of hypoxemia in patients with different stroke ischemic stroke were analyzed. High TG and diabetes were also independent risk factors of low HDL-C in patients with different subtype ischemic stroke; the history of statin use was closely related to low HDL-C in SAD patients (OR value =2). .0202, P=0.002). It shows that hyperTG is also a common type of lipid metabolism in Asian people, while high TG can reduce HDL-C levels through a variety of mechanisms: hyperTG can weaken the activity of lecithin cholesterol acyl transferase (LCAT) and lipoprotein esterase (LPL), thus causing HDL-C metabolism to be blocked; and the cholera of patients with high TG emia The activity of alcohol ester transfer protein (CETP) is enhanced, which causes the loss of cholesterol transported by HDL-C, causing HDL-C remodeling and decreasing the content of HDL-C in blood. As an independent risk factor for low HDL-C, diabetes is not only direct glycosylation of protein in HDL-C with hyperglycemia, but also the decrease of HDL-C level, and diabetes, islets of pancreas. Factor resistance and impaired glucose utilization, on the one hand, can promote the decrease of HDL-C level in adipose and inflammatory reactions; on the other hand, it is necessary to actively control the risk factors of the patient's vascular disease by promoting the increase of TG secretion by promoting the increase of TG secretion, especially in the early stage of diabetes combined with high TG. Intervention. As a retrospective study, the types and duration of statins used in the selected patients were different, and different statins were different. Therefore, the risk factors of low HDL-C in the history of statins application were not sure, and the risk factors for.3 in isolated and low HDL-C were analyzed: male, diabetes mellitus History of the use of statins is an independent risk factor for isolated low HDL-C disease risk (OR value 2.557,1.754,2.152 respectively; P value is 0.000,0.017,0.002 respectively). It shows that the risk factors of isolated hypoxemia are equivalent to low HDL-C, which should be considered as a risk factor for ischemic stroke. The prevalence of hypoxemia in ischemic stroke patients was up to 64.2%, especially in LAA patients; males, hypertriglyceridemia and diabetes were risk factors for hypoxemia in ischemic stroke patients, and smoking and drinking history were independent risk factors for low HDL-C in male ischemic stroke patients.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R743.3

【參考文獻】

相關(guān)期刊論文 前5條

1 袁旭東;龐曉;;原發(fā)性高血壓患者高密度脂蛋白與血壓變異性的關(guān)系[J];吉林醫(yī)學(xué);2014年10期

2 李沙,蔣仲謀;血清HDL-C測定對肝病診斷價值的臨床觀察[J];陜西醫(yī)學(xué)檢驗;1996年03期

3 劉曉艷;路倩;陳五軍;唐朝克;;高密度脂蛋白膽固醇水平相關(guān)的遺傳學(xué)研究最新進展[J];生物化學(xué)與生物物理進展;2012年12期

4 邢立影;王健松;張慧英;;高血壓患者合并心血管病危險因素現(xiàn)狀分析[J];中國醫(yī)藥導(dǎo)報;2011年26期

5 謝娟,來則民,黃國偉,木村美惠子;高密度脂蛋白膽固醇(HDL-CH)異常的危險因素研究[J];中國公共衛(wèi)生;2000年11期

，

本文編號：1956305