【作者】 李伟；

【导师】 刘鸣；

【作者基本信息】 四川大学 ， 神经病学， 2005， 硕士

【摘要】 目的:了解影响脑卒中急性期血脂水平(甘油三酯、胆固醇)的因素;了解脑卒中急性期血脂水平与死亡、死亡/残疾及复发关系;探索急性期血脂水平是否为脑卒中预后的独立预测因子。 病例与方法:1.前瞻性的登记2003年3月1日至2005年3月1日期间,在四川大学华西医院神经内科连续性入院的脑卒中患者,纳入发病24小时内的缺血性和出血性脑卒中患者;于入院次晨测量空腹血脂,并全面收集与预后有关的其他临床资料;随访1月、3月、6月和12月末的死亡、残疾和复发等结局。2.血清胆固醇(total cholesterol TC)≥6.0mmol/L定义为高胆固醇,血清甘油三酯(triglyceride TG)≥2.0mmol/L定义为高甘油三酯。将年龄、性别、卒中类型、入院时病情严重程度等可能影响入院时血脂的因素作为自变量,血清高TC水平以及血清高TG水平作为应变量做单因素和多因素Logistic回归分析,了解影响急性期血脂的因素。对血脂及其他临床特征与预后的关系采用Logistic多因素回归分析。 结果:1.纳入发病24小时内的脑卒中患者共649例,其中缺血性脑卒中395例(60.9%),出血性脑卒中254例(39.1%)。入院时患者的血清TG水平范围是0.65～4.99mmol/L,平均1.43±0.89mmol/L;血清TG≥2.0mmol/L者有174例(26.8%),<2.0mmol/L者有475例(73.2%)。血清TC水平范围是1.51～8.00mmol/L,平均4.62±1.19mmol/L;血清TC≥6.0mmol/L者更多还原

【Abstract】 Objective: To investigate the factor associated with serum lipid level in acute stage of stroke. To observe the correlation of serum lipid level in acute stage of stroke and the prognosis. The aim of this study was whether serum lipid level in acute stage of stroke is independent factor associated prognosis or not.Materials and method: The consecutive cases of stroke were prospectively registered in the neurology wards of the West China Hospital, Sichuan Univercity from Mar 1,2003 to Mar 1,2005,of which only the patients within 24 hours from stroke onset were included in the study. Fasting samples of serum lipid estimation were drawn in the next morning of admission, and other data related outcomes were obtained routinely. The outcomes were followed up at the end of 1,3,6 and 12 month after ictus. The outcome measurement was death, dependence and recurrence. The raised serum cholesterol was defmded as the total cholesterol(TC) concentration ≥ 6.0mmol/L, and elevated serum triglyceride(TG) was the level of it≥ 2.0mmol/L .The rasied serum cholesterol and triglyceride were analyzed in relation to age, sex, stroke type, stroke severity, etc by using univariate and multivariate logistic regression respectively to evaluate the factors associated with serum lipid in acute stage stroke. Logistic regression was used toestimate the correlation of serum lipid and prognosis.Results: The total cases of 649 ischemic and hemorrhagic stroke within 24 hours from onset were included. The serum TG range on admission was 0.65 ~ 4.99 mmol/L,and the total of 174 patients had elevated serum triglyceride level. The serum TC range on admission was 1.51 - 8.00 mmol/L(mean,4.62± 1.19mmol/L), and the total of 77 cases had raised serum cholesterol level (≥6.0mmol/L). Independent factors related serum TG and TC level on admission were stroke type and stroke severity. The patients with ischemic stroke had significantly higher serum TC and TG level on admission than those of patients with hemorrhagic stroke. Cholesterol concentration was not a significant predictor of death at the end of first and third month, while triglyceride concentration was. The difference of death and death/disability between two groups is significant. Prognosis of patients with higher TG level was better than that of patients with lower TG level at the end of first and third month.Conclusion: The patients with hemorrhagic stroke had significant lower serum TC and TG level on admission than those of patients with ischemic stroke. Independent factors related serum TG and TC level on admission were stroke type and stroke severity. The patients with ischemic stroke and severe stroke performance could have higher serum TC and TG, and vice versa. Time from stroke onset to adimission and age didn’t affect serum TC and TG level on admission. Cholesterol concentration was not a significant predictor of death and death/disability at the end of first and third month, while triglyceride concentration was. The patients with higher serum TG level on admission had better outcome at the end of first and third month.更多还原