不同严重程度颅内动脉粥样硬化患者代谢指标的差异及其对脑动脉狭窄和闭塞的预测价值

The differences in metabolic indicators among patients with intracranial atherosclerosis of different severity levels and their predictive value for cerebral artery stenosis and occlusion

摘要:

目的]探究不同严重程度颅内动脉粥样硬化患者代谢指标的差异及其对脑动脉狭窄和闭塞的预测价值。 [方法]选取2022年2月—2024年2月在本院接受治疗的310例疑似颅内动脉粥样硬化患者,根据是否发生脑动脉狭窄和闭塞分为正常组(n＝155)和闭塞组(n＝155)。闭塞患者根据颅内动脉粥样硬化分级不同,分为1级组(n＝40)、2级组(n＝78)和3级组(n＝37)。比较不同动脉粥样硬化分级患者的临床资料、血清钙磷代谢指标水平；广义相加模型(GAM)分析血清钙磷代谢指标水平与动脉粥样硬化分级的关系；比较闭塞组与正常组的临床资料；多因素Logistic回归分析影响脑动脉狭窄和闭塞的因素；分析血清钙磷代谢指标水平与脑动脉狭窄和闭塞的剂量-反应关系；比较不同动脉粥样硬化分级及不同血清钙磷代谢指标水平下的脑动脉狭窄与闭塞的差异；广义线性模型分析颅内动脉粥样硬化严重程度对脑动脉狭窄和闭塞与血清钙磷代谢指标水平之间关联性的影响。 [结果]随着动脉粥样硬化分级水平的升高,空腹血糖(FBG)、高敏C反应蛋白(hs-CRP)、载脂蛋白B(ApoB)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDLC)、血磷、钙磷乘积、全段甲状旁腺激素(iPTH)水平逐渐升高,而载脂蛋白A(ApoA)、高密度脂蛋白胆固醇(HDLC)水平逐渐降低(P＜0.05)；GAM分析结果显示,血磷、钙磷乘积、iPTH对动脉粥样硬化分级的影响为正向作用；与正常组相比,闭塞组的FBG、hs-CRP、ApoB、TC、TG、LDLC、血磷、钙磷乘积、iPTH水平显著升高,ApoA、HDLC水平显著降低(P＜0.05)；与正常组相比,闭塞组动脉粥样硬化分级为0级的患者明显更少(P＜0.05)；ApoA≤1.02 g/L、ApoB＞1.09 g/L、TC＞5.31 mmol/L、TG＞2.53 mmol/L、LDLC＞3.12 mmol/L、HDLC≤1.26 mmol/L、血磷＞2.17 mmol/L、钙磷乘积＞4.53 (mmol/L)²、iPTH＞327.49 ng/L、动脉粥样硬化分级≥1级是脑动脉狭窄和闭塞的危险因素(P＜0.05)；血磷、钙磷乘积、iPTH与脑动脉狭窄和闭塞的关联强度呈非线性剂量-反应关系(P＜0.001)；随着动脉粥样硬化分级的升高,脑动脉狭窄与血磷、钙磷乘积、iPTH的正相关关系逐渐增强。 [结论]不同严重程度颅内动脉粥样硬化患者代谢指标水平存在明显差异,且对脑动脉狭窄和闭塞具有预测价值。

Abstract:

Aim To explore the differences in metabolic indicators among patients with intracranial atherosclerosis of different severity levels and their predictive value for cerebral artery stenosis and occlusion. MethodsA total of 310 patients with suspected intracranial atherosclerosis who were treated in our hospital from February 2022 to February 2024 were selected, and they were divided into the normal group (n＝155) and the occlusion group (n＝155) based on whether cerebral artery stenosis and occlusion occurred. Patients in the occlusion group were divided into grade 1 group (n＝40), grade 2 group (n＝78) and grade 3 group (n＝37) according to the grade of intracranial atherosclerosis.The clinical data and serum calcium and phosphorus metabolism indicator levels of patients with different grades of atherosclerosis were compared. The generalized additive model (GAM) was used to analyze the relationship between the levels of serum calcium and phosphorus metabolism indicators and the grade of atherosclerosis. The clinical data of the occlusion group and the normal group were compared. Multivariate Logistic regression analysis was conducted to analyze the factors affecting cerebral artery stenosis and occlusion. The dose-response relationship between the levels of serum calcium and phosphorus metabolism indicators and cerebral artery stenosis and occlusion was analyzed. The differences in cerebral artery stenosis and occlusion under different grades of atherosclerosis and different levels of serum calcium and phosphorus metabolism indicators were compared. The generalized linear model was used to analyze the influence of the severity of intracranial atherosclerosis on the association between cerebral artery stenosis and occlusion and the levels of serum calcium and phosphorus metabolism indicators. Results With the increase of atherosclerosis grading level, the levels of fasting blood glucose (FBG), high sensitivity C-reactive protein (hs-CRP), apolipoprotein B (ApoB), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDLC), blood phosphorus, calcium-phosphorus product, and intact parathyroid hormone (iPTH) gradually increased, while the levels of apolipoprotein A (ApoA) and high density lipoprotein cholesterol (HDLC) gradually decreased (P＜0.05). The results of GAM analysis showed that blood phosphorus, calcium-phosphorus product and iPTH had a positive effect on atherosclerosis grading. Compared with normal group, the levels of FBG, hs-CRP, ApoB, TC, TG, LDLC, blood phosphorus, calcium-phosphorus product and iPTH were significantly higher in occlusion group, and the levels of ApoA and HDLC were significantly lower (P＜0.05). Compared with the normal group, there were significantly fewer patients with atherosclerosis grade 0 in the occlusion group (P＜0.05). ApoA≤1.02 g/L, ApoB＞1.09 g/L, TC＞5.31 mmol/L, TG＞2.53 mmol/L, LDLC＞3.12 mmol/L, HDLC≤1.26 mmol/L, blood phosphorus＞2.17 mmol/L, calcium-phosphorus product＞4.53 (mmol/L)², iPTH＞327.49 ng/L and atherosclerosis grade≥1 were the risk factors for cerebral artery stenosis and occlusion (P＜0.05). The correlation intensity of blood phosphorus, calcium-phosphorus product, iPTH and cerebral artery stenosis and occlusion showed a non-linear dose-response relationship (P＜0.001). With the increase of atherosclerosis grading, the positive correlation between cerebral artery stenosis and blood phosphorus, calcium-phosphorus product and iPTH gradually increased. Conclusion There were significant differences in the levels of metabolic indicators among patients with intracranial atherosclerosis of different severity levels, and they had predictive value for cerebral artery stenosis and occlusion.