Yu Xiaofan, Ge Peicong, Zhai Yuanren, Wang Rong, Zhang Yan, Zhang Dong
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Front Neurol. 2022 Jul 26;13:891622. doi: 10.3389/fneur.2022.891622. eCollection 2022.
Previous studies have reported that hypo-high-density lipoproteinemia (HHDL) was an independent risk factor for the cerebrovascular event. However, the risk of HHDL for stroke recurrence in moyamoya disease (MMD) during long-term follow-up after revascularization remains poorly understood. We aim to investigate the association between HHDL and stroke recurrence in adult patients with MMD.
A total of 138 adult patients with MMD were prospectively recruited from 1 July to 31 December 2019. After excluding 15 patients who did not meet the inclusion criteria, all the 123 patients were enrolled. Participants were grouped according to the stroke recurrence and HHDL presentation, respectively. Clinical data and laboratory examinations were compared by the statistical analysis. The Kaplan-Meier survival analysis was conducted to compare the stroke-free survival rates between participants with HHDL and those without. Univariate and multivariate logistic regression analyses were performed to identify independent factors of the neurological status. Univariate and multivariate Cox regression analyses were conducted to identify the predictors for the recurrent stroke.
Participants with recurrent stroke group showed a lower level of high-density lipoprotein (HDL) ( = 0.030). More participants in the recurrent stroke group had HHDL ( = 0.045). What is more, there was statistical significance in the Kaplan-Meier curve of stroke incidence between the normal HDL group and the HHDL group (log-rank test, = 0.034). Univariate logistic analysis results showed that HHDL (OR 0.916, 95% CI 0.237-3.543; = 0.899) and HDL (OR 0.729, 95% CI 0.094-5.648; = 0.763) were not predictive factors for the neurological status. In the multivariate Cox regression analysis, diabetes (HR 4.195, 95% CI 1.041-16.899; = 0.044), HDL (HR 0.061, 95% CI 0.006-0.626; = 0.019), and HHDL (HR 3.341, 95% CI 1.110-10.051; = 0.032) were independent risk factors for the recurrent stroke.
Hypo-high-density lipoproteinemia might be a predictor or the potential therapeutic target for recurrent stroke during the long-term follow-up after revascularization in adult patients with MMD.
既往研究报道低高密度脂蛋白血症（HHDL）是脑血管事件的独立危险因素。然而，对于烟雾病（MMD）患者血管重建术后长期随访期间HHDL导致卒中复发的风险仍知之甚少。我们旨在研究成年MMD患者中HHDL与卒中复发之间的关联。
2019年7月1日至12月31日前瞻性招募了138例成年MMD患者。排除15例不符合纳入标准的患者后，共纳入123例患者。参与者分别根据卒中复发情况和HHDL表现进行分组。通过统计分析比较临床资料和实验室检查结果。采用Kaplan-Meier生存分析比较有HHDL和无HHDL参与者的无卒中生存率。进行单因素和多因素逻辑回归分析以确定神经功能状态的独立因素。进行单因素和多因素Cox回归分析以确定复发性卒中的预测因素。
复发性卒中组参与者的高密度脂蛋白（HDL）水平较低（P = 0.030）。复发性卒中组中更多参与者存在HHDL（P = 0.045）。此外，正常HDL组和HHDL组之间卒中发生率的Kaplan-Meier曲线存在统计学意义（对数秩检验，P = 0.034）。单因素逻辑分析结果显示，HHDL（比值比[OR]0.916，95%置信区间[CI]0.237 - 3.543；P = 0.899）和HDL（OR 0.729，95% CI 0.094 - 5.648；P = 0.763）不是神经功能状态的预测因素。在多因素Cox回归分析中，糖尿病（风险比[HR]4.195，95% CI 1.041 - 16.899；P = 0.044）、HDL（HR 0.061，95% CI 0.006 - 0.626；P = 0.019）和HHDL（HR 3.341，95% CI 1.110 - 10.051；P = 0.032）是复发性卒中的独立危险因素。
低高密度脂蛋白血症可能是成年MMD患者血管重建术后长期随访期间复发性卒中的预测因素或潜在治疗靶点。
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