神经系统健康人群的血脂参数与颈动脉斑块之间的相关性

doi:10.3969/j.issn.1673-5765.2024.12.010

摘要/Abstract

摘要： 目的探讨在神经系统健康人群中，血脂参数与颈动脉斑块（carotid plaque，CP）之间的相关性。
方法回顾性连续纳入2022年10月—2023年10月在首都医科大学附属北京天坛医院健康管理中心进行健康检查的神经系统健康人群。受试者接受了标准化问卷调查、体格检查、颈部血管超声以及实验室检测。通过标准颈动脉超声成像技术评估CP情况。CP的定义为颈动脉内膜-中层厚度≥1.5 mm。采用logistic回归和限制性立方样条（restricted cubic spline，RCS）分析血脂参数与CP的相关性。此外，绘制ROC曲线，并使用AUC、95％CI和最佳截断值等指标评估血脂参数对CP的预测能力。
结果共纳入13 939名受试者，中位年龄42（35～52）岁，其中7501名（53.81%）为女性，2936名（21.06%）有CP。多因素logistic回归分析显示，校正混杂因素后，与低水平组相比，高水平的TC、TG、LDL-C、HDL-C、残余胆固醇、非高密度脂蛋白胆固醇、载脂蛋白B和载脂蛋白B/载脂蛋白A1比值与CP呈正相关；高水平的HDL-C和载脂蛋白A1与CP呈负相关。其中，载脂蛋白B/载脂蛋白A1比值与CP的关联最强（OR 1.85，95%CI 1.59～2.16，P＜0.001；趋势性P＜0.001）。RCS曲线显示除HDL-C和载脂蛋白A1外，其他血脂参数均与CP之间存在非线性关系。残余胆固醇在所有血脂参数中对CP的预测效果最佳，其AUC值为0.65（95%CI 0.64～0.66），最佳截断值为0.33 mmol/L。
结论在神经系统健康人群中，血脂参数与CP有独立相关性，其中载脂蛋白B/载脂蛋白A1比值与CP的相关性最强。残余胆固醇在识别CP方面为最佳的血脂参数。

文章导读： 本研究强调了血脂参数，尤其是载脂蛋白B/载脂蛋白A1比值和残余胆固醇，在神经系统健康人群中识别颈动脉斑块的关键作用，为心脑血管疾病的早期筛查和预防提供了重要依据。

关键词: 颈动脉斑块; 血脂参数; 神经系统健康人群

Abstract: Objective To explore the correlation between lipid parameters and carotid plaque (CP) in the neurologically healthy population.
Methods This retrospective study consecutively enrolled neurologically healthy individuals who underwent health examinations at the Health Management Center of Beijing Tiantan Hospital, Capital Medical University from October 2022 to October 2023. Subjects completed standardized questionnaires, physical examinations, cervical vascular ultrasound, and laboratory tests. CP was evaluated by standard carotid ultrasound imaging. CP was defined as carotid intima-media thickness≥1.5 mm. Logistic regression and restricted cubic spline (RCS) were used to analyze the correlation between lipid parameters and CP. Additionally, ROC curves were plotted, and the predictive ability of lipid parameters for CP was evaluated using indicators such as AUC, 95%CI, and optimal cutoff values.
Results A total of 13 939 subjects were included, with a median age of 42 (35-52) years. Among them, 7501 (53.81%) were female, and 2936 (21.06%) had CP. Multivariate logistic regression analysis showed that after adjusting for confounding factors, compared to the low level group, high levels of TC, TG, LDL-C, HDL-C, residual cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein B, and the apolipoprotein B/apolipoprotein A1 ratio were positively correlated with CP. Conversely, high levels of HDL-C and apolipoprotein A1 were negatively correlated with CP. Among them, the apolipoprotein B/apolipoprotein A1 ratio showed the strongest correlation with CP (OR 1.85, 95%CI 1.59-2.16, P<0.001; P for trend<0.001). RCS curves showed that except for HDL-C and apolipoprotein A1, other lipid parameters exhibited a nonlinear relationship with CP. Residual cholesterol had the best predictive effect for CP among all lipid parameters, with an AUC value of 0.65 (95%CI 0.64-0.66), and the optimal cutoff value was 0.33 mmol/L.
Conclusions Lipid parameters were independently correlated with CP in the neurologically healthy population, and the apolipoprotein B/apolipoprotein A1 ratio had the strongest correlation with CP. Residual cholesterol was the best lipid parameter in identifying CP.

Key words: Carotid plaque; Lipid parameter; Neurologically healthy population

中图分类号:

李雯博, 刘阳, 刘洁, 郭齐瑞, 张莹, 郑华光. 神经系统健康人群的血脂参数与颈动脉斑块之间的相关性[J]. 中国卒中杂志, 2024, 19(12): 1433-1440.

LI Wenbo, LIU Yang, LIU Jie, GUO Qirui, ZHANG Ying, ZHENG Huaguang. Correlation between Lipid Parameters and Carotid Plaque in the Neurologically Healthy Population[J]. Chinese Journal of Stroke, 2024, 19(12): 1433-1440.

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