Huang Yin Fei, Liu Zhen Xing, Cen Kuan, Zhang Ren Wei, Xiang Qiao Yuan, Cai Qi, Yang Chun Jiao, Luo Lei, Xu Hai Long, Xie Yu, Liu Yu Min
Department of Neurology, Zhongnan Hospital Affiliated to Wuhan University, Wuhan, Hubei, China.
Department of Neurology, Yiling Hospital of Yichang City, Yichang, Hubei, China.
Front Neurol. 2025 Jul 9;16:1564966. doi: 10.3389/fneur.2025.1564966. eCollection 2025.
OBJECTIVE: Moderate-to-severe stenosis has been identified as a significant risk factor for stroke recently. This study aims to investigate the relationship between non-traditional lipid parameters and the location and distribution of stenosis, as well as symptomatic events, in patients with moderate-to-severe intracranial atherosclerotic stenosis (ICAS) and extracranial atherosclerotic stenosis (ECAS). METHODS: This study analyzed correlation between non-traditional lipid parameters and moderate-to-severe ICAS and ECAS concerning stenosis location, distribution, and the presence or absence of symptoms. Logistic models and restricted spline analysis were utilized to explore the relationship between Castelli's risk index-II (CRI-II) and the occurrence of stroke events. RESULTS: The present study comprised 1,030 participants, of whom 143 were non-stenotic and 887 were patients with moderate-to-severe stenosis. The study focuses on the latter and indicated statistically significant differences in AIP, LCI, RC, AC, CRI-I, and CRI-II among the three groups of ICAS, ECAS, and combined ICAS and ECAS ( = 0.012, 0.005, 0.013, 0.009, 0.009, 0.032, respectively). Lipid parameters for ICAS were generally higher than those for ECAS. Remnant cholesterol (RC) exhibited a discrepancy among the anterior, posterior, and combined anterior and posterior circulation stenosis groups ( = 0.047). Logistic regression analysis revealed that CRI-II (Odds ratio [OR] = 1.20, Confidence interval [CI] 1.03-1.40, = 0.009) and low-density lipoprotein cholesterol (LDL-c) (OR = 1.21, CI 1.03-1.42, = 0.011) demonstrated remarkable elevations in symptomatic stenosis patients compared to patients without symptoms. After adjusting for potential confounding factors, CRI-II remained an independent risk factor for symptomatic stenosis. Furthermore, multivariate spline regression modeling elucidated that an augmented risk of stroke events in moderate-to-severe stenosis was associated with an elevated CRI-II. As CRI-II elevated, the risk of stroke events increased progressively.
目的：近期，中重度狭窄已被确认为中风的重要危险因素。本研究旨在调查非传统血脂参数与中重度颅内动脉粥样硬化狭窄（ICAS）和颅外动脉粥样硬化狭窄（ECAS）患者狭窄的部位和分布以及症状性事件之间的关系。 方法：本研究分析了非传统血脂参数与中重度ICAS和ECAS在狭窄部位、分布以及有无症状方面的相关性。采用逻辑模型和受限样条分析来探讨卡斯泰利风险指数-II（CRI-II）与中风事件发生之间的关系。 结果：本研究共纳入1030名参与者，其中143名无狭窄，887名患有中重度狭窄。本研究聚焦于后者，结果表明，ICAS、ECAS以及ICAS合并ECAS三组在动脉粥样硬化指数（AIP）、脂蛋白胆固醇指数（LCI）、残余胆固醇（RC）、非高密度脂蛋白胆固醇（AC）、CRI-I以及CRI-II方面存在统计学显著差异（分别为P = 0.012、0.005、0.013、0.009、0.009、0.032）。ICAS的血脂参数总体高于ECAS。残余胆固醇（RC）在前循环、后循环以及前后循环联合狭窄组之间存在差异（P = 0.047）。逻辑回归分析显示，与无症状患者相比，症状性狭窄患者的CRI-II（比值比[OR] = 1.20，置信区间[CI] 1.03 - 1.40，P = 0.009）和低密度脂蛋白胆固醇（LDL-c）（OR = 1.21，CI 1.03 - 1.42，P = 0.011）显著升高。在调整潜在混杂因素后，CRI-II仍然是症状性狭窄的独立危险因素。此外，多变量样条回归模型表明，中重度狭窄患者中风事件风险增加与CRI-II升高有关。随着CRI-II升高，中风事件风险逐渐增加。
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