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急性缺血性卒中患者血清脂质与临床结局的关联:一项系统评价和荟萃分析。

Association of serum lipids with clinical outcome in acute ischaemic stroke: A systematic review and meta-analysis.

作者信息

Deng Qiwen, Li Shuo, Zhang Hanqing, Wang Huan, Gu Zhengtian, Zuo Lei, Wang Lvyue, Yan Fuling

机构信息

Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China; Department of Neurology, Nanjing First Hospital, Nanjing Medical University. Nanjing, China.

Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.

出版信息

J Clin Neurosci. 2019 Jan;59:236-244. doi: 10.1016/j.jocn.2018.09.003. Epub 2018 Sep 19.

Abstract

Serum lipid levels have been investigated as prognostic markers in patients with acute ischaemic stroke. However, these results remain inconsistent. This study aimed at assessing the association between serum lipid and clinical outcomes in acute ischaemic stroke. Relevant data were obtained from Cochrane Library, PubMed and Web of Science databases. The heterogeneity of pooled results was determined by the Cochran's Q test and Higgins I-squared statistic. The random-effect model was performed to calculate the pooled results if P < 0.05 for Q-test, otherwise the fixed-effect model was applied. The primary results were death, and the secondary were recurrence, dependency, mRS score ≥3, and early neurological deterioration. A total of 21 full-text studies was included in the present study. For primary results, the pooled results from 5 studies with 4119 patients showed that triglyceride (TG) was a significant predictor for death (OR = 0.65, 95%CI = 0.43-0.98, P = 0.028). The pooled data from 11 studies with 12,486 patients for total cholesterol (TC), 4 studies with 7593 patients for low-density lipoprotein cholesterol (LDL-C), and 5 studies with 6933 patients for high-density lipoprotein cholesterol (HDL-C) suggested that TC (OR = 0.79, 95%CI = 0.56-1.13, P < 0.001), LDL-C (OR = 1.02, 95%CI = 0.66-1.57, P = 0.042), and HDL-C (OR = 1.18, 95%CI = 0.75-1.86, P = 0.003) were not associated with death in acute ischaemic stroke. For secondary results, the pooled results of 2 studies with 867 patients indicated that TG was positively associated with early neurological deterioration. This study suggested that serum TG was associated with death and early neurological deterioration in acute ischaemic stroke.

摘要

血清脂质水平已被作为急性缺血性脑卒中患者的预后标志物进行研究。然而,这些结果仍不一致。本研究旨在评估急性缺血性脑卒中患者血清脂质与临床结局之间的关联。相关数据来自考克兰图书馆、PubMed和科学网数据库。采用Cochran's Q检验和Higgins I²统计量来确定合并结果的异质性。若Q检验的P<0.05,则采用随机效应模型计算合并结果,否则应用固定效应模型。主要结果为死亡,次要结果为复发、依赖、改良Rankin量表(mRS)评分≥3以及早期神经功能恶化。本研究共纳入21项全文研究。对于主要结果,5项研究共4119例患者的合并结果显示,甘油三酯(TG)是死亡的显著预测因素(OR=0.65,95%CI=0.43-0.98,P=0.028)。11项研究共12486例患者的总胆固醇(TC)、4项研究共7593例患者的低密度脂蛋白胆固醇(LDL-C)以及5项研究共6933例患者的高密度脂蛋白胆固醇(HDL-C)的合并数据表明,TC(OR=0.79,95%CI=0.56-1.13,P<0.001)、LDL-C(OR=1.02,95%CI=0.66-1.57,P=0.042)和HDL-C(OR=1.18,95%CI=0.75-1.86,P=0.003)与急性缺血性脑卒中的死亡无关。对于次要结果,2项研究共867例患者的合并结果表明,TG与早期神经功能恶化呈正相关。本研究提示,血清TG与急性缺血性脑卒中的死亡和早期神经功能恶化有关。

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