Weir Christopher J, Sattar Naveed, Walters Matthew R, Lees Kennedy R
Acute Stroke Unit, University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, UK.
Cerebrovasc Dis. 2003;16(1):76-82. doi: 10.1159/000070119.
Recent data have shown an unexpected association between poor outcome after acute stroke and lower serum cholesterol. Triglyceride concentration has been linked to coronary heart disease and stroke; however, there are currently no data on the relationship between triglyceride and stroke outcome. Such information may yield further mechanistic information on the relationship between lipids and stroke outcome.
We studied 1,310 nondiabetic patients presenting to our acute stroke unit with computed tomography-confirmed acute stroke. Fasting blood samples were drawn within 24 h of admission for glucose, lipids and a standard battery of biochemistry and hematological tests. Information on age, stroke type, admission blood pressure, smoking status, presence of atrial fibrillation, resolution time of symptoms and Oxfordshire Community Stroke Project clinical classification was collated. Stepwise proportional hazards regression was used to estimate the effect of the above variables on survival following stroke.
Increased age (p < 0.0001), presence of atrial fibrillation (p = 0.009), hyperglycemia (p = 0.0005) and lower triglyceride level (p < 0.0001) independently predicted higher mortality; early resolution of symptoms (p = 0.005) independently predicted lower mortality. Although serum cholesterol level predicted outcome after adjusting for other prognostic factors, it did not remain significant when triglyceride level was entered into the model. The relative hazard per additional quartile of triglyceride was 0.84 (95% confidence interval 0.77-0.91).
Low triglyceride concentration strongly predicts higher mortality following stroke, whereas serum cholesterol level is not an independent predictor. Outcome following stroke is thus related more strongly to triglyceride-rich than to cholesterol-rich lipoprotein concentrations. The mechanisms explaining this require further investigation.
近期数据显示，急性卒中后预后不良与血清胆固醇水平较低之间存在意外关联。甘油三酯浓度与冠心病和卒中有关；然而，目前尚无关于甘油三酯与卒中预后关系的数据。此类信息可能会为脂质与卒中预后之间的关系提供更多的机制信息。
我们研究了1310例非糖尿病患者，这些患者因计算机断层扫描确诊为急性卒中而入住我们的急性卒中单元。入院后24小时内采集空腹血样，检测血糖、血脂以及一系列标准的生化和血液学指标。整理了患者的年龄、卒中类型、入院血压、吸烟状况、房颤情况、症状缓解时间以及牛津郡社区卒中项目临床分类等信息。采用逐步比例风险回归分析来评估上述变量对卒中后生存的影响。
年龄增加（p < 0.0001）、存在房颤（p = 0.009）、高血糖（p = 0.0005）以及甘油三酯水平较低（p < 0.0001）独立预测较高的死亡率；症状早期缓解（p = 0.005）独立预测较低的死亡率。尽管在调整其他预后因素后血清胆固醇水平可预测预后，但当将甘油三酯水平纳入模型时，其不再具有显著性。甘油三酯每增加一个四分位数的相对风险为0.84（95%置信区间0.77 - 0.91）。
低甘油三酯浓度强烈预测卒中后较高的死亡率，而血清胆固醇水平并非独立预测因素。因此，卒中后的预后与富含甘油三酯的脂蛋白浓度的关系比与富含胆固醇的脂蛋白浓度的关系更为密切。解释这一现象的机制需要进一步研究。
