The Short-term Prognostic Value of the Triglyceride-to-high-density Lipoprotein Cholesterol Ratio in Acute Ischemic Stroke.
The Short-term Prognostic Value of the Triglyceride-to-high-density Lipoprotein Cholesterol Ratio in Acute Ischemic Stroke.
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DOI：
10.14336/ad.2017.0629
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发表时间：
2018-06
影响因子：
7.4
通讯作者：
Yan FL
中科院分区：
文献类型：
--
作者：
Deng QW;Li S;Wang H;Lei L;Zhang HQ;Gu ZT;Xing FL;Yan FL
甘油三酯（TG）与高密度脂蛋白胆固醇（HDL-C）比值（TG/HDL-C）是预测心血管疾病不良结局的一种简单方法。TG/HDL-C对急性缺血性卒中的影响尚不清楚。本研究的目的是研究TG/HDL-C对急性缺血性卒中（AIS）后3个月死亡率的确切影响。本研究从2011年至2017年入组了AIS患者。来自中国一个城市的1459名参与者被分为回顾性培训和前瞻性测试队列。定期收集医疗记录，以确定致死性事件的发生率。所有参与者都被跟踪了3个月。使用X-tile软件确定最佳截止值，以基于其脂质水平将训练队列患者分为较高和较低生存组。使用Kaplan-Meier曲线和考克斯比例风险回归模型进行生存分析。共分析了1459例AIS患者（中位年龄68.5岁，58.5%为男性）。单因素考克斯回归分析证实TG/HDL-C是影响3个月生存率的重要预后因素。X-tile将0.9确定为TG/HDL-C的最佳临界值。单因素分析显示，TG/HDL-C >0.9组预后明显上级TG/HDL-C ≤0.9组（P<0.001）。多变量考克斯回归分析显示TG/HDL-C与死亡风险降低独立相关（风险比[HR]，0.39; 95%可信区间[CI]，0.24-0.62; P<0.001）。这些结果在测试队列的453名患者中得到证实。构建了预测3个月病死率的列线图，训练组和试验组的预测准确率c指数分别为0.684和0.670（P<0.01）。血清TG/HDL-C比值可能有助于预测AIS后的短期死亡率。
The triglyceride (TG)-to-high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) is a simple approach to predicting unfavorable outcomes in cardiovascular disease. The influence of TG/HDL-C on acute ischemic stroke remains elusive. The purpose of this study was to investigate the precise effect of TG/HDL-C on 3-month mortality after acute ischemic stroke (AIS). Patients with AIS were enrolled in the present study from 2011 to 2017. A total of 1459 participants from a single city in China were divided into retrospective training and prospective test cohorts. Medical records were collected periodically to determine the incidence of fatal events. All participants were followed for 3 months. Optimal cutoff values were determined using X-tile software to separate the training cohort patients into higher and lower survival groups based on their lipid levels. A survival analysis was conducted using Kaplan-Meier curves and a Cox proportional hazards regression model. A total of 1459 patients with AIS (median age 68.5 years, 58.5% male) were analyzed. Univariate Cox regression analysis confirmed that TG/HDL-C was a significant prognostic factor for 3-month survival. X-tile identified 0.9 as an optimal cutoff for TG/HDL-C. In the univariate analysis, the prognosis of the TG/HDL-C >0.9 group was markedly superior to that of TG/HDL-C ≤0.9 group (P<0.001). A multivariate Cox regression analysis showed that TG/HDL-C was independently correlated with a reduced risk of mortality (hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.24-0.62; P<0.001). These results were confirmed in the 453 patients in the test cohort. A nomogram was constructed to predict 3-month case-fatality, and the c-indexes of predictive accuracy were 0.684 and 0.670 in the training and test cohorts, respectively (P<0.01). The serum TG/HDL-C ratio may be useful for predicting short-term mortality after AIS.