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目的评价颈动脉内-中膜厚度(CIMT)与血脂(包括脂质、脂蛋白、载脂蛋白)、超敏C反应蛋白(hs-CRP)、空腹血糖、年龄、性别等因素间的相关性。方法回顾性分析2009年9月—2010年3月在广州市红十字会医院神经内科和心内科住院,年龄≥40岁的833例患者的临床资料,包括采用超声测量的平均CIMT、性别、年龄、血脂水平[脂质、脂蛋白、载脂蛋白,以及脂质比值,包括低密度脂蛋白胆固醇(LDL-C)与高密度脂蛋白胆固醇(HDL-C)的比值、载脂蛋白B(Apo-B)与载脂蛋白A-Ⅰ(ApoA-Ⅰ)的比值及总胆固醇(TC)与HDL-C的比值]、hs-CRP、空腹血糖等资料。依据患者的CIMT,分为正常组(平均CIMT<1.0 mm)172例,增厚组(平均CIMT≥1.0 mm)661例。采用二元Logistic回归分析筛选出CIMT增厚的独立危险因素。结果①增厚组患者的年龄、空腹血糖、hs-CRP、LDL-C/HDL-C比值、TC/HDL-C比值、Apo-B/ApoA-Ⅰ比值的中位数,均高于正常组,而HDL-C、ApoA-Ⅰ的中位数低于正常组。增厚组男性例数要明显多于正常组,差异有统计学意义,均P<0.05。两组之间其他变量差异无统计学意义。②二元Logistic回归显示,年龄(OR=1.085,95%CI:1.067～1.104)、男性(OR=1.897,95%CI:1.985～2.799)、hs-CRP(OR=1.165,95%CI:1.047～1.296)、LDL-C/HDL-C比值(OR=1.281,95%CI:1.040～1.579)是预测CIMT增厚的独立危险因素。结论 LDL-C/HDL-C比值增高是预测心脑疾病患者CIMT增厚的独立危险因素,其预测作用可能要优于单独检测LDL-C或HDL-C。
Objective To evaluate the relationship between carotid intima - media thickness (CIMT) and plasma lipids (including lipids, lipoproteins, apolipoproteins), hs - CRP, fasting blood glucose, age and gender . Methods The clinical data of 833 patients aged 40 years and older who were hospitalized in Department of Neurology and Cardiology of Guangzhou Red Cross Hospital from September 2009 to March 2010 were retrospectively analyzed. The mean CIMT, gender, age , Lipid levels [lipid, lipoprotein, apolipoprotein, and lipid ratio, including the ratio of low-density lipoprotein cholesterol (LDL-C) to high density lipoprotein cholesterol (HDL-C), apolipoprotein B B) to apolipoprotein A-Ⅰ (ApoA-Ⅰ) ratio and the ratio of total cholesterol (TC) to HDL-C], hs-CRP and fasting blood glucose. According to the patient’s CIMT, there were 172 patients in the normal group (mean CIMT <1.0 mm) and 661 patients in the thickened group (mean CIMT≥1.0 mm). Binary Logistic regression analysis was used to screen independent risk factors for CIMT thickened. Results ① The median age, fasting glucose, hs-CRP, LDL-C / HDL-C ratio, TC / HDL-C ratio and Apo-B / ApoA-Ⅰ ratio in patients with thickened group were significantly higher than those in normal group , While the median of HDL-C and ApoA-I was lower than that of normal group. Thickening group of male cases was significantly more than the normal group, the difference was statistically significant, all P <0.05. The other variables between the two groups showed no significant difference. ② Logistic regression analysis showed that age (OR = 1.085,95% CI: 1.067-1.104), hs-CRP (OR = 1.97, 95% CI: 1.985-2.799) ~ 1.296). The LDL-C / HDL-C ratio (OR = 1.281, 95% CI: 1.040-1.579) was an independent risk factor for predicting CIMT thickening. Conclusions The higher LDL-C / HDL-C ratio is an independent risk factor for predicting CIMT thickening in patients with cardiovascular and cerebrovascular diseases. Its predictive value may be superior to that of LDL-C or HDL-C alone.