Sun Zhaoyuan, Liu Jinzhi, Wang Aihua, Si Zhihua
Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Jinan, China.
Sci Rep. 2025 Mar 11;15(1):8343. doi: 10.1038/s41598-025-93074-6.
Small and dense LDL cholesterol (sdLDL-C) and apolipoprotein B (ApoB) have important roles in promoting the development of atherosclerosis and are highly correlated with the degree of atherosclerosis. Several studies have found differences in anterior and posterior circulation strokes and in the mechanisms of their atherosclerosis, but little research has been done on the relationship of sdLDL-C and ApoB to atherosclerotic stenosis in anterior and posterior circulation strokes. We analyzed the correlation between sdLDL-C and ApoB and the degree of arterial stenosis in patients with posterior circulation stroke. We included 230 anterior circulation stroke (ACS) patients and 170 posterior circulation stroke (PCS) patients. Blood specimens were collected at admission, serum ApoB and sdLDL-C concentrations were measured, and the degree of arterial stenosis was determined on the basis of vascular imaging. We analyzed the predictive value of ApoB and sdLDL-C for the degree of cerebral artery stenosis in patients with PCS. For patients with nonmild stenosis, sdLDL-C and ApoB levels were higher in the PCS group than in the ACS group (P < 0.05). SdLDL-C (P < 0.001) and ApoB (P < 0.05) were independent risk factors for increased intracranial artery stenosis in the posterior circulation group. Binary logistic regression analysis showed that sdLDL-C (P < 0.05) and ApoB (P < 0.05) were independent risk factors for non-mild stenosis of the intracranial arteries in patients with PCS after correction for confounders. In the posterior circulation group, there was an interaction between the effects of sdLDL and ApoB on intracranial artery stenosis, P < 0.05. Plotting the ROC curve showed that the AUC of the combined detection of sdLDL-C and ApoB was 0.791, which was better than that of the single index. We built nomogram model, the DCA curves, calibration curves, NRI index, and IDI index of both the modeling and validation groups indicated that the diagnostic efficacy and clinical benefit of the combined sdLDL-C and ApoB assay were greater than those of single-indicator assays for cerebral artery stenosis in posterior circulation stroke. Risk factors contributing to the increased degree of intracranial arterial stenosis in ACS and PCS vary somewhat. SdLDL-C and ApoB may be of value in clinical decision making as predictors of cerebral arterial stenosis in patients with PCS.
小而密低密度脂蛋白胆固醇（sdLDL-C）和载脂蛋白B（ApoB）在促进动脉粥样硬化发展中起重要作用，且与动脉粥样硬化程度高度相关。多项研究发现前循环和后循环卒中存在差异及其动脉粥样硬化机制不同，但关于sdLDL-C和ApoB与前循环和后循环卒中动脉粥样硬化狭窄的关系研究较少。我们分析了后循环卒中患者sdLDL-C和ApoB与动脉狭窄程度的相关性。我们纳入了230例前循环卒中（ACS）患者和170例后循环卒中（PCS）患者。入院时采集血标本，检测血清ApoB和sdLDL-C浓度，并根据血管成像确定动脉狭窄程度。我们分析了ApoB和sdLDL-C对PCS患者脑动脉狭窄程度的预测价值。对于非轻度狭窄患者，PCS组的sdLDL-C和ApoB水平高于ACS组（P＜0.05）。SdLDL-C（P＜0.001）和ApoB（P＜0.05）是后循环组颅内动脉狭窄增加的独立危险因素。二元逻辑回归分析显示，校正混杂因素后，sdLDL-C（P＜0.05）和ApoB（P＜0.05）是PCS患者颅内动脉非轻度狭窄的独立危险因素。在后循环组中，sdLDL和ApoB对颅内动脉狭窄的影响存在交互作用，P＜0.05。绘制ROC曲线显示，sdLDL-C和ApoB联合检测的AUC为0.791，优于单一指标。我们构建了列线图模型，建模组和验证组的DCA曲线、校准曲线、NRI指数和IDI指数均表明，联合检测sdLDL-C和ApoB对后循环卒中脑动脉狭窄的诊断效能和临床获益大于单一指标检测。导致ACS和PCS患者颅内动脉狭窄程度增加的危险因素有所不同。SdLDL-C和ApoB作为PCS患者脑动脉狭窄的预测指标，可能在临床决策中具有价值。
