Zhao Chun Xia, Cui Ying Hua, Fan Qiao, Wang Pei Hua, Hui Ruitai, Cianflone Katherine, Wang Dao Wen
Department of Internal Medicine, Institute of Hypertension, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China.
Cerebrovasc Dis. 2009;27(1):99-104. doi: 10.1159/000175768. Epub 2008 Nov 22.
Low-density lipoproteins (LDL) are a heterogeneous group of particles, with small, dense particles being more atherogenic. It remains controversial whether elevated plasma levels of small dense LDL (sd-LDL) are risk factors for stroke. The aim of the present study was to examine the plasma levels of sd-LDL in patients with stroke and to investigate the associations in a large Chinese case-control study.
We recruited 299 stroke patients (159 cerebral thrombosis, 42 lacunar infarction, 98 intracerebral hemorrhage) and 299 controls. The semiquantitative analysis of plasma levels of sd-LDL was performed by nondenaturing gradient gel electrophoresis.
(1) The plasma levels of sd-LDL in patients with ischemic stroke or hemorrhagic stroke were higher than in controls. (2) Multiple regression analysis showed that there were significant relationships between sd-LDL and triglyceride, high-density lipoprotein cholesterol, LDL cholesterol, systolic blood pressure and history of diabetes, and a significant relationship between sd-LDL and stroke (r = 0.286, p < 0.001) even after adjusting for these factors. (3) Compared with the controls, the calculation of odds ratios indicated relative risk estimates of 3.111 for ischemic stroke (OR = 3.111 , 95% CI = 1.891-5.117, p < 0.001) and 3.164 for hemorrhagic stroke (OR = 3.164, 95% CI = 1.632-6.137, p < 0.01).
Plasma sd-LDL was independently associated with both thrombotic and hemorrhagic stroke, suggesting it may be an independent predictor of as well as a risk factor for stroke in Chinese people, justifying clinical trials for primary and secondary prevention of stroke using statins or fibrates.
低密度脂蛋白（LDL）是一组异质性颗粒，其中小而致密的颗粒更具致动脉粥样硬化性。血浆中小而致密LDL（sd-LDL）水平升高是否为中风的危险因素仍存在争议。本研究的目的是检测中风患者的血浆sd-LDL水平，并在一项大型中国病例对照研究中调查其相关性。
我们招募了299例中风患者（159例脑血栓形成、42例腔隙性梗死、98例脑出血）和299例对照。采用非变性梯度凝胶电泳对血浆sd-LDL水平进行半定量分析。
（1）缺血性中风或出血性中风患者的血浆sd-LDL水平高于对照组。（2）多元回归分析显示，即使在调整这些因素后，sd-LDL与甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、收缩压和糖尿病史之间仍存在显著关系，且sd-LDL与中风之间存在显著关系（r = 0.286，p < 0.001）。（3）与对照组相比，比值比计算表明缺血性中风的相对风险估计值为3.111（OR = 3.111，95%CI = 1.891 - 5.117，p < 0.001），出血性中风为3.164（OR = 3.164，95%CI = 1.632 - 6.137，p < 0.01）。
血浆sd-LDL与血栓性和出血性中风均独立相关，表明它可能是中国人中风的独立预测指标和危险因素，这为使用他汀类药物或贝特类药物进行中风一级和二级预防的临床试验提供了依据。
