Miao Shuchuan, Wang Xiaoyan, Guo Jiulin, You Chao
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Neurosurgery, Chengdu Seventh People's Hospital, Chengdu, China.
BMC Neurol. 2025 Mar 28;25(1):131. doi: 10.1186/s12883-025-04099-3.
Previous results on the association between HDL (high-density lipoprotein cholesterol) levels and intracranial aneurysm (IA) rupture were controversial. We aimed to investigate the association between HDL levels and the risk of IA rupture.
Medical records of patients with solitary IA diagnosed at West China Hospital of Sichuan University were reviewed and analyzed between December 2008 and March 2023. Univariable and multivariable logistic regression analyses were performed to determine the effects of HDL levels on IA rupture risk. A three-piece-wise logistic regression model with smoothing was used to analyze different association thresholds between HDL and the risk of IA rupture after adjusting for confounding factors.
Univariable and multivariable logistic regression analysis showed the independent association between HDL and IA rupture. After being adjusted for confounders, different U-shaped relationships were found between HDL levels and the risk of IA in males, females, and all patients. Compared to HDL in the range of 0.9 ~ 1.3 mmol/L, patients had 79% [OR (95%CI):1.79(1.16 ~ 2.78), p = 0.009] increase of rupture when lower than 0.9 mmol/L, 60% [OR (95%CI):1.6(1.19 ~ 2.17), p = 0.002] increase when higher than 1.3 mmol/L before or after adjusted confounders. We found gender differences in the HDL range of IA rupture; the lowest range of HDL was 1.1 ~ 1.4 mmol/L in females and 0.8 ~ 1.1 mmol/L in males.
There was a U-shaped relationship between HDL levels and the risk of IA rupture. People with HDL levels between 0.9 and 1.3 mmol/L are least likely to experience IA rupture in the Chinese population.
既往关于高密度脂蛋白胆固醇（HDL）水平与颅内动脉瘤（IA）破裂之间关联的研究结果存在争议。我们旨在探讨HDL水平与IA破裂风险之间的关联。
回顾性分析2008年12月至2023年3月期间在四川大学华西医院确诊为孤立性IA的患者的病历。进行单变量和多变量逻辑回归分析，以确定HDL水平对IA破裂风险的影响。采用带平滑处理的三段式逻辑回归模型，在调整混杂因素后分析HDL与IA破裂风险之间的不同关联阈值。
单变量和多变量逻辑回归分析显示HDL与IA破裂之间存在独立关联。在调整混杂因素后，男性、女性和所有患者的HDL水平与IA风险之间均呈现不同的U型关系。与HDL水平在0.9至1.3 mmol/L范围内相比，HDL水平低于0.9 mmol/L时，患者破裂风险增加79%[比值比（95%置信区间）：1.79（1.16至2.78），p = 0.009]；高于1.3 mmol/L时，无论是否调整混杂因素，破裂风险均增加60%[比值比（95%置信区间）：1.6（1.19至2.17），p = 0.002]。我们发现IA破裂的HDL范围存在性别差异；女性HDL的最低范围为1.1至1.4 mmol/L，男性为0.8至1.1 mmol/L。
HDL水平与IA破裂风险之间存在U型关系。在中国人群中，HDL水平在0.9至1.3 mmol/L之间的人发生IA破裂的可能性最小。
