Relationship Between Remnant Cholesterol And Carotid Plaque In Patients With Large-Artery Arteriosclerosis Ischemic Stroke

Objective: Remnant cholesterol（RC）plays an important role in the formation of carotid plaque,and is also closely related to the occurrence and development of ischemic stroke（IS）.This study attempts to explore the relationship between RC and carotid plaque in patients with large-artery atherosclerotic IS,in order to find more valuable serological indicators.Methods: From January 1,2019 to December 31,2019,608 patients with ischemic stroke of large-artery atherosclerotic type（LAA）were analyzed retrospectively.The clinical data of the patients were collected and RC was calculated according to the formula.All patients were divided into 4 groups according to the quartile of RC levels.We analyzed the relationship between RC and other related indexes.Multivariate Logistic regression was used to determine the independent risk factors of carotid plaque.The area under ROC curve was used to analyze the ability of RC and other combined indexes to predict the occurrence of carotid plaque.Results: After grouping patients with LAA ischemic stroke according to different RC levels,the results showed that in terms of laboratory indexes,there were significant differences in white blood cell count,neutrophil count,red blood distribution width standard deviation,fasting blood glucose,triglyceride,total cholesterol,high density lipoprotein cholesterol,non-high density lipoprotein cholesterol,TG/HDL-C,LDLC/HDL-C and TC/HDL-C between low RC group and high RC group.Between medium high RC group and high RC group,there were also significant differences in white blood cell count,neutrophil count,fasting blood glucose,triglyceride,total cholesterol,non-high density lipoprotein cholesterol,TG/HDL-C and TC/HDL-C.In terms of carotid artery color Doppler ultrasound data,there were significant differences in carotid plaque（yes or no）,carotid plaque number of 0 or 2 or more,left carotid plaque number of 0,bilateral carotid artery mixed plaque number of 0,maximum plaque area and Crouse score level between medium high RC group and high RC group.There were also significant differences in carotid plaques（yes or no）,carotid plaque number of 0,strong echo plaques in the right carotid artery（yes or no）,the number of strong echo plaques in bilateral carotid arteries is 0 and the maximum plaque area between the low RC group and the high RC group.Spearman correlation analysis showed that with the increase of serum RC level,the proportion of patients with carotid plaque increased,that is,serum RC was positively correlated with carotid plaque.Univariate analysis and multivariate Logistic regression analysis of carotid plaque showed that age（OR=1.070,95%CI=1.049-1.091,P=0.000）,fasting blood glucose（OR=1.114,95%CI=1.021-1.214,P=0.015）,RC（OR=22.797,95%CI=2.938-176.880,P=0.003）,LDLC/HDL-C（OR=16.215,95%CI=2.586-101.670,P=0.003）,and maximum CIMT（OR=72389000.000,95%CI=70.626-（7E+13）,P=0.010）were independent risk factors for carotid plaque in patients with LAA ischemic stroke.TC/HDL-C OR=0.151,95%CI=0.041-0.562,P=0.005)is an independent protective factor of carotid plaque in patients with LAA ischemic stroke.ROC curve analysis showed: maximum CIMT（AUC=0.726,95%CI=0.675-0.776,P=0.000）,RC（AUC=0.561,95%CI=0.512-0.609,P=0.018）,RC combined with fasting blood glucose and LDL-C/HDL-C（AUC=0.641,95%CI=0.595-0.688,P=0.000）,RC combined with age and LDLC/HDL-C（AUC=0.731,95%CI=0.687-0.774,P=0.000）,RC combined with fasting blood glucose and age（AUC=0.736,95%CI=0.693-0.779,P=0.003）,RC combined with fasting blood glucose and TC/HDL-C（AUC=0.641,95%CI=0.594-0.687,P=0.000）,RC combined with age and TC/HDL-C（AUC=0.729,95%CI=0.685-0.773,P=0.000）,RC combined with LDL-C/HDL-C and TC/HDL-C（AUC=0.593,95%CI=0.545-0.641,P=0.000）all have certain diagnostic value for carotid plaque in patients with LAA ischemic stroke.Among them,as one of the gold standards for the diagnosis of carotid plaque,the maximum CIMT has the highest sensitivity of 99.3%,cutoff value of 0.098 and specificity of 60.9%.The diagnostic value of RC alone in carotid plaque was not good（AUC=0.561）.In the diagnosis of RC combined with other indexes,the area under the curve of RC combined with fasting blood glucose and age has the largest and higher than the maximum CIMT（AUC=0.736）,and the diagnostic value is greater,with a cutoff value of 0.582,a sensitivity of 84.9%,and a specificity of 50.5%.Conclusions: High level of RC should go hand in hand with carotid plaque in patients with LAA ischemic stroke,at the same time is an independent risk factor for carotid plaque.Compared with the maximum CIMT,the ROC curve of RC combined with fasting blood glucose and age is helpful to improve the diagnostic value of carotid plaque in patients with LAA ischemic stroke.