血脂与颈动脉斑块形成的临床关联研究
田作军1 刘磊1 廖海星1 汤庆2 温燕航2 肖霭仪2 董亚贤1 李少明1 邵明1
（1广州医学院第一附属医院神经内科，广东、广州 510120；2广州医学院第一附属医院B超室，广东、广州 510120）
摘要 目的：研究血脂与颈动脉斑块形成之间的临床关联。方法：收集2005年6月至2006年12月在我院检查颈动脉彩超的住院患者279例，先对颈总动脉的内膜－中层厚度（IMT）行多重回归、对颈动脉有无斑块分组行二项分类Logistic回归筛选其影响因素，再分析血脂四项指标与颈动脉的斑块积分、斑块指数及IMT之间的偏相关性分析，并比较有无斑块两组血脂四项指标的大小。最后对血脂四项指标绘制ROC曲线评价其对颈动脉斑块的预测价值。结果：在对IMT的多重回归中低密度脂蛋白（LDL）被作为危险因素之一筛选出来（B = 0.055, P = 0.048），但在二项分类Logistic回归中血脂四项指标均被剔除。LDL与IMT之间呈正相关（r = 0.120, P = 0.048）。颈动脉有无斑块两组间血脂四项指标无统计学意义。四项指标的ROC曲线下面积均小于0.7（P均 0.05），对有无斑块形成没有预测价值。结论：LDL与颈动脉的IMT增厚有关，但血脂四项指标与颈动脉斑块的形成不平行，对颈动脉有无斑块形成没有预测价值。
关键词 颈动脉斑块；血脂；统计
Clinical association between blood lipid and the formation of carotid plaqueTIAN Zuo-jun, Liu Lei, Liao Hai-xing, Tang Qing, Wen Yan-Hang, Xiao Ai-yi, DONG Ya-xian, LI Shao-ming, SHAO Ming.
( 1Department of Neurology, 2Department of Medical Ultrasonics, First Affiliaited Hospital, Guangzhou Medical College, Guangzhou 510120, China)
Abstract Objective: To explore the Clinical association between blood lipid and the formation of carotid plaque. Methods: From Jun 2005 to December 2006, the data of 279 hospital patients undergoing the examination of cervical part artery color Doppler ultrasonography were collected. Firstly, Multinomial regression was used to screen out the influencing factors of the intima-media thickness (IMT) of carotid artery, and binary logistic regression was used to screen out the influencing factors of the formation of carotid plaque. Then correlation was analysis between the four index of blood lipid and the Crouse score and index of carotid plaque and the IMT of carotid artery by partial correlation, and the four index of blood lipid were comparsed between the group with carotid plaque and the group without carotid plaque. Finally, receiver operating characteristic (ROC) curves of the four index of blood lipid were used to predict the presence of carotid plaque. Results: Inthe multinomial regression model of IMT, the low density lipoprotein (LDL) was screen out as a risk factor (B = 0.055, P = 0.048), while in the binary logistic regression model, all of the four index of blood lipid were excluded. Positive correlation was shown between LDL and the IMT (r = 0.120, P = 0.048). NO statistical difference of the four index of blood lipid was found between the group with carotid plaque and the group without carotid plaque. All of the area under the ROC cures of the four index of blood lipidwas less than 0.7 (P all 0.05), and the four index of blood lipid could not predict the presence of carotid plaque. Conclusion: LDL has relation to the IMT of carotid artery, while the four index of blood lipid don’t parallel the formation of carotid plaque and cannot predict the presence of carotid plaque.
Key words Carotid plaque; Blood lipid; Statistics
颈动脉粥样硬化是全身动脉粥样硬化比较集中的部分。研究发现它与人类主要致死性脑血管疾病、冠心病关系密切，对其病因及危险因素的研究有重要临床价值。动脉粥样硬化是一个多病因疾病，与年龄、吸烟、高血脂、高血压等多因素相关，迄今研究认为血脂代谢异常是其最主要危险因素[1]。本文收集在本院查颈动脉彩超患者的临床资料分析血脂水平与颈动脉粥样硬化及斑块形成之间的临床关联性。
1 材料与方法
1.1 一般资料
收集2005年6月－2006年12月在本院B超室检查颈动脉彩超的住院患者279例，男130例，女149例；年龄31～96岁，平均（67.19±11.64）岁。高血压病188例，糖尿病65例，脑梗塞99例；冠心病51例，总胆固醇（TC） 5.5 mmol/L的169例；甘油三酯（GT） 1.58 mmol/L 105例；高密度脂蛋白（HDL）≥1.17 mmol/L的163例；低密度脂蛋白（LDL） 2.6 mmol/L的195例，2.0～2.6 mmol/L53例， 2.0 mmol/L31例。
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