非传统脂质参数在预测颅内动脉粥样硬化狭窄患者血管内治疗后再狭窄中的作用。
Roles of Nontraditional Lipid Parameters for Predicting Restenosis in Patients with Intracranial Atherosclerotic Stenosis After Endovascular Treatment.
机构信息
Cerebrovascular Disease Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, 510120, Guangzhou, Guangdong, China.
Guangdong Provincial Chinese Emergency Key Laboratory, 510120, Guangzhou, China.
出版信息
Clin Neuroradiol. 2024 Dec;34(4):827-840. doi: 10.1007/s00062-024-01409-z. Epub 2024 Jun 19.
PURPOSE
Nontraditional lipid parameters are associated with intracranial atherosclerotic stenosis (ICAS) progression. This study aimed to investigate the association of nontraditional lipid parameters with the risk of restenosis in patients with ICAS after endovascular treatment (EVT).
METHODS
This study retrospectively enrolled consecutive patients with symptomatic ICAS after successful EVT followed by at least 3 months of angiography. Participants were divided into restenosis or non-restenosis groups based on the angiographic follow-up results. The nontraditional lipid parameters were calculated from conventional lipid parameters. The COX regression models and restricted cubic splines (RCS) were used to explore the association between nontraditional lipid parameters and restenosis.
RESULTS
This study recruited 222 cases with 224 lesions eligible for our study, of which 56 (25%) had restenosis. Compared with the non-restenosis group, patients in the restenosis group had higher levels of the atherogenic index of plasma (AIP) (0.211, interquartile range, IQR, 0.065-0.404 vs. 0.083, IQR, -0.052-0.265, P = 0.001), remnant cholesterol (RC) (0.55, IQR, 0.33-0.77 vs. 0.30, IQR, 0.18-0.49, P < 0.001) and Castelli's index‑I (CRI-I) (4.13, IQR, 3.39-5.34 vs. 3.74, IQR, 2.94-4.81, P = 0.030). In the multivariable COX regression analysis, a 0.1 unit increase of AIP was an independent risk factor for restenosis (hazard ratio, HR = 1.20, 95% confidence interval, CI 1.05-1.35, P = 0.005) whereas such an association was not observed for RC (HR = 1.01, 95% CI 0.90-1.15, P = 0.835). The restricted cubic spline (RCS) plot revealed a linear relationship between AIP and restenosis (P for nonlinear = 0.835) but a nonlinear relationship for RC (P for nonlinear = 0.012). Patients were stratified according to tertiles (T) of AIP and RC and the risk of restenosis increased in T3 compared to T1 (HR = 3.21, 95% CI 1.35-7.62, P = 0.008 and HR = 2.99, 95% CI 1.11-8.03, P = 0.030, respectively). Furthermore, this association remained stable within each LDL‑C level subgroup.
CONCLUSION
The AIP and RC were positively and independently associated with restenosis in patients with ICAS after EVT.
目的
非传统脂质参数与颅内动脉粥样硬化性狭窄（ICAS）进展相关。本研究旨在探讨非传统脂质参数与血管内治疗（EVT）后 ICAS 患者再狭窄风险之间的关系。
方法
本研究回顾性纳入了成功 EVT 后至少进行了 3 个月血管造影随访的有症状性 ICAS 连续患者。根据血管造影随访结果，将患者分为再狭窄或非再狭窄组。非传统脂质参数是由常规脂质参数计算得出的。采用 COX 回归模型和限制性立方样条（RCS）来探讨非传统脂质参数与再狭窄之间的关系。
结果
本研究共纳入了 222 例符合研究条件的患者，共 224 处病变，其中 56 例（25%）发生了再狭窄。与非再狭窄组相比，再狭窄组患者的血浆致动脉粥样硬化指数（AIP）（0.211，四分位距 IQR，0.065-0.404 与 0.083，IQR，-0.052-0.265，P=0.001）、残余胆固醇（RC）（0.55，IQR，0.33-0.77 与 0.30，IQR，0.18-0.49，P<0.001）和 Castelli 指数-I（CRI-I）（4.13，IQR，3.39-5.34 与 3.74，IQR，2.94-4.81，P=0.030）水平更高。在多变量 COX 回归分析中，AIP 每增加 0.1 单位是再狭窄的独立危险因素（危险比 HR=1.20，95%置信区间 CI 1.05-1.35，P=0.005），而 RC 则无此关联（HR=1.01，95% CI 0.90-1.15，P=0.835）。限制性立方样条（RCS）图显示 AIP 与再狭窄之间存在线性关系（非线性 P=0.835），而 RC 则存在非线性关系（非线性 P=0.012）。根据 AIP 和 RC 的三分位数（T）对患者进行分层，与 T1 相比，T3 患者的再狭窄风险增加（HR=3.21，95% CI 1.35-7.62，P=0.008 和 HR=2.99，95% CI 1.11-8.03，P=0.030）。此外，在每个 LDL-C 水平亚组内，这种关联仍然稳定。
结论
AIP 和 RC 与 EVT 后 ICAS 患者的再狭窄呈正相关且独立相关。
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