| Background:With the increasing trend of the aging population in China,stroke has become one of the main chronic diseases affecting the mortality rate in China,with ischemic stroke as the main one.Both dyslipidemia and type 2 diabetes are common independent risk factors for ischemic stroke.At the same time,it is also a common chronic disease in China,so the secondary prevention of ischemic stroke is the focus of our national health management in recent years.As research progresses,the value of non-traditional lipid parameters other than LDL-C such as TC / HDL-C,TG / HDL-C,Apo B / Apo A-I for monitoring diseases such as cerebral infarction has been found.However,recent studies have found that patients with type 2 diabetes are susceptible to changes in HDL structure and function that affect the correlation between HDL and cerebral infarction.So far,the correlation between nontraditional lipid parameters and ischemic stroke is few and far between cardiovascular diseases.Little research has been done on ischemic stroke patients with type 2 diabetes.Objective:This study intends to collect the clinical data of acute cerebral infarction patients with type 2 diabetes,analyze a series of studies on the correlation between non-traditional lipid parameters and acute cerebral infarction patients with type 2 diabetes,and explore whether non-traditional lipid parameters are superior to traditional lipid parameters in monitoring acute cerebral infarction in patients with type 2 diabetes.Methods:1.We retrospectively collected the data of 1015 patients with acute cerebral infarction complicated with type 2 diabetes who were hospitalized in the Affiliated Hospital of Yangzhou University from January 1,2019 to December 31,2021.According to the inclusion and exclusion criteria,the integrity of case data,patient compliance and follow-up,303 patients who met the criteria were finally included.2.According to the clinical manifestations and MRI imaging data of the patients,the patients were divided into two groups: anterior circulation group and posterior circulation group.The baseline data of the two groups were analyzed,and the severity of cerebral infarction was evaluated by using the expanded version of the National Institutes of Health Stroke Scale(e-NIHSS)score.The traditional blood lipid parameters were analyzed by spearman correlation analysis Correlation between non-traditional blood lipid parameters and AIS severity of anterior circulation and posterior circulation in patients with type 2 diabetes3.We collected patients with carotid atherosclerotic plaques,and plaques were classified according to pathological characteristics as follows: unstable plaques(mixed echoic,isoechoic and hypoechoic and plaques)and stable plaques(hyperechoic calcified plaques).Logistic regression analysis was used to analyze the independent risk factors of carotid unstable plaque in AIS patients with type 2diabetes,and the ratio of each independent risk factor was compared.(odds ratio,OR)4.The included patients were followed up and evaluated with the modified Rankin scale(m Rs).Patients with 90 d m RS score of 0～2 were defined as good prognosis,and patients with 90 d m RS score ≥ 3 were defined as poor prognosis.The receiver operating characteristic(ROC)curve was used to compare the area under curve(AUC)of non-traditional blood lipid parameters and traditional blood lipid parameters to predict the short-term prognosis of AIS,and to observe the predictive efficacy of non-traditional blood lipid parameters and their optimal cutoff value.Results:1.Baseline: A total of 303 patients with type 2 diabetes were included,including 201 patients in the anterior circulation infarction group and 102 patients in the posterior circulation infarction group.There was no statistical significance between the baseline data of the two groups.Spearman correlation analysis showed that TC/HDL-C(p<0.01),TG/HDL-C(p<0.01),Apo B/Apo A-I(p<0.01)and LDLC/HDL-C(p < 0.05)of non-traditional blood lipid parameters in the anterior circulation infarction group were significantly related to the severity of anterior circulation AIS with type 2 diabetes,with statistical significance.Among the traditional blood lipid parameters,TC(p<0.05)and TG(p<0.01)were significantly positively correlated,with statistical significance.The non-traditional blood lipid parameters TC/HDL-C(p<0.01),TG/HDL-C(p<0.05),Apo B/Apo A-I(p<0.01)and LDL-C/HDL-C(p < 0.01)in the posterior circulation infarction group were all statistically related to the severity of anterior circulation AIS with type 2 diabetes.TC(p<0.01)in traditional blood lipid parameters showed a significant positive correlation,with statistical significance.2.Logistic regression analysis of independent risk factors for carotid unstable plaque in AIS patients with type 2 diabetes included gender,age,BMI,history of hypertension,history of diabetes,history of smoking,history of drinking,nontraditional lipid parameters,and traditional lipid parameters into the logic diagram regression model.TG/HDL-C(OR=19.610,95%CI 1.187-323.865)、 LDLC/HDL-C(OR=7227.659,95%CI 3.886-13444262.448)、TC(OR=11110.171,95%CI 6.299-19597379.9)、 TG(OR=0.019,95%CI 0.001-0.563)and LDLC(OR=0.000,95%CI 0.000-0.243)are an independent risk factor for unstable carotid plaque in AIS patients with type 2 diabetes.3.ROC analysis of the prediction efficiency of the main outcome indicators: In terms of predicting the 90 day prognosis of AIS patients with type 2 diabetes,the nontraditional lipid parameters TG/HDL-C(AUC=0.650,P<0.01),TC/HDL-C(AUC=0.644,P<0.01),Apo B/Apo A-I(AUC=0.597,P<0.01)and LDL-C/HDL-C(AUC=0.579,P<0.05)have statistical significance,Among the traditional blood lipid parameters,TG(AUC=0.629,P<0.01)and 1/HDL-C(AUC=0.589,P<0.01).The sensitivity and specificity of TG/HDL-C were 59.7% and 66.8% respectively;The sensitivity and specificity of TC/HDL-C were 62.7% and 60.9% respectively;The sensitivity and specificity of Apo B/Apo A-I were 61.3% and 56.5% respectively;The sensitivity and specificity of LDL-C/HDL-C were 58% and 58.7% respectively;The sensitivity and specificity of TG were 91.6% and 29.3% respectively;1/The sensitivity and specificity of HDL-C were 91.6% and 29.3% respectively.Among them,TG/HDL-C,a non-traditional blood lipid parameter,has a better predictive effect.Conclusion:1.Compared with traditional lipid parameters,non-traditional lipid parameters have a stronger correlation with AIS severity in patients with type 2 diabetes.2.The elevation of TG / HDL-C and LDL-C / HDL-C in non-traditional lipid parameters are independent risk factors for the presence of an unstable carotid plaque in AIS patients with type 2 diabetes.3.Among non-traditional lipid parameters,TC / HDL-C,TG / HDL-C,LDL-C / HDLC,and Apo B / Apo A-I showed the predictive value for 90-day prognosis in AIS patients with type 2 diabetes,and among all unconventional lipid parameters,TG /HDL-C had the highest predictive value. |
PDF Full Text Request