Li Zheng, Zhang Jiahui, Luo Yun
Department of Rehabilitation, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University.
Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Medicine (Baltimore). 2020 Sep 4;99(36):e21792. doi: 10.1097/MD.0000000000021792.
Major lipids making effects on the occurrence of acute ischemic stroke (AIS) is well recognized, but their roles on stroke severity remain uncertain. To explore the exact roles of lipids playing on stroke severity and the possible mechanism, we conduct this observational study.Data was collected from patients with AIS from February 2008 to May 2012. The level of major lipids was compared among AIS groups with different severity and investigated the correlation. Also, the relationship existed between major lipids and bilirubin. Mechanism of major lipids playing on stroke severity was researched to determine if oxidative stress reflected by bilirubin.Lower triglyceride (TG) and higher high density lipoprotein cholesterol (HDL-C) were observed in severe stroke, and obvious correlation existed between TG and stroke severity or HDL-C and stroke severity. TG was associated negatively with direct bilirubin (DBIL) and total bilirubin (TBIL), and lower level of DBIL and TBIL were related to higher quartiles of TG. There was no obvious difference of DBIL and TBIL among the groups of quartiles of HDL-C. TG was the influence factor of stroke severity in severe stroke through multiple univariable logistic regression. But it was not the independent influence factor after multivariable logistic regression adjusted by DBIL or TBIL. However, HDL-C was the influence factor of stroke severity through both univariable and multivariable logistic regression.Lower TG or higher HDL-C predicted severer stroke. The effect of TG on stroke severity was mediated by bilirubin, not HDL-C.
主要脂质对急性缺血性卒中(AIS)发生的影响已得到充分认识,但其对卒中严重程度的作用仍不明确。为探讨脂质在卒中严重程度中的确切作用及可能机制,我们开展了这项观察性研究。
数据收集自2008年2月至2012年5月的AIS患者。比较不同严重程度AIS组的主要脂质水平并研究其相关性。此外,研究主要脂质与胆红素之间的关系。研究主要脂质对卒中严重程度的作用机制,以确定胆红素所反映的氧化应激是否起作用。
在重症卒中患者中观察到甘油三酯(TG)水平较低和高密度脂蛋白胆固醇(HDL-C)水平较高,且TG与卒中严重程度或HDL-C与卒中严重程度之间存在明显相关性。TG与直接胆红素(DBIL)和总胆红素(TBIL)呈负相关,DBIL和TBIL水平较低与TG较高四分位数相关。HDL-C四分位数组之间的DBIL和TBIL无明显差异。通过多变量单因素逻辑回归分析,TG是重症卒中严重程度的影响因素。但在经DBIL或TBIL调整的多变量逻辑回归分析后,它不是独立影响因素。然而,HDL-C通过单变量和多变量逻辑回归分析均为卒中严重程度的影响因素。
较低的TG或较高的HDL-C预示着更严重的卒中。TG对卒中严重程度的影响由胆红素介导,而非HDL-C。