Amarenco Pierre, Labreuche Julien, Elbaz Alexis, Touboul Pierre-Jean, Driss Fathi, Jaillard Assia, Bruckert Eric
Department of Neurology and Stroke Centre, Bichat Hospital, Denis Diderot University, INSERM U-360, Paris, France.
Cerebrovasc Dis. 2006;22(2-3):101-8. doi: 10.1159/000093237. Epub 2006 May 9.
Little is known about the relationship between hypercholesterolaemia and specific aetiological subtypes of brain infarction (BI).
In a cross-sectional study of 492 pairs of patients with a BI proven by MRI and matched hospital controls, we determined the blood levels of triglycerides, total, HDL and LDL cholesterol, and apolipoprotein A(1) and B, in the same centralized laboratory. We performed aetiological BI subtype classification.
Except for triglycerides, the risk of BI increased continuously with the lipid levels, without any heterogeneity between the main BI subtypes or the group on lipid-lowering therapy. The adjusted odds ratio per standard deviation in LDL cholesterol (0.93 mmol/l) was 1.74 (95% confidence interval, 1.02-2.98) in atherothrombotic strokes (n = 109) and 2.71 (95% confidence interval, 1.60-4.55) in lacunar strokes (n = 105). Eighty percent of patients were above the ATP-III guideline threshold LDL cholesterol of 2.59 mmol/l (100 mg/dl), with a major contribution of both atherothrombotic and lacunar stroke subtypes to this group.
These findings suggest that blood lipids, particularly total and LDL cholesterol levels, are associated with all subtypes of BI, and that LDL above 2.59 mmol/l is highly prevalent.
关于高胆固醇血症与脑梗死（BI）特定病因亚型之间的关系，人们了解甚少。
在一项对492对经MRI证实患有BI的患者及相匹配的医院对照者的横断面研究中，我们在同一中央实验室测定了甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇以及载脂蛋白A(1)和B的血液水平。我们进行了病因性BI亚型分类。
除甘油三酯外，BI的风险随血脂水平持续增加，在主要的BI亚型之间或接受降脂治疗的组之间没有任何异质性。在动脉粥样硬化血栓形成性卒中（n = 109）中，低密度脂蛋白胆固醇每标准差（0.93 mmol/l）的调整优势比为1.74（95%置信区间，1.02 - 2.98），在腔隙性卒中（n = 105）中为2.71（95%置信区间，1.60 - 4.55）。80%的患者低密度脂蛋白胆固醇高于ATP - III指南阈值2.59 mmol/l（100 mg/dl），动脉粥样硬化血栓形成性和腔隙性卒中亚型对此组有主要贡献。
这些发现表明血脂，尤其是总胆固醇和低密度脂蛋白胆固醇水平，与BI的所有亚型相关，且高于2.59 mmol/l的低密度脂蛋白非常普遍。
