非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值和颅内/颅外动脉严重粥样硬化性狭窄之间的相关性研究

陈玲; 吕达平; 姚明; 汪永全; 汪玲

doi:10.16766/j.cnki.issn.1674-4152.004160

非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值和颅内/颅外动脉严重粥样硬化性狭窄之间的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.004160

陈玲¹,
吕达平¹,
姚明¹,
汪永全¹,
汪玲^2, ,

1.
安徽医科大学第一附属医院/安徽省公共卫生临床中心神经内科，安徽合肥 230011
2.
皖南医学院第一附属医院神经内科，安徽芜湖 241000

基金项目:

安徽省省委共建项目/青年项目 AHWJ2024Aa30270

安徽医科大学第一附属医院北区科研基金项目 2024YKJ12

详细信息

通讯作者:
汪玲，E-mail: sunflower0904@163.com

中图分类号: R743.1
计量
- 文章访问数: 4
- HTML全文浏览量: 2
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-04-03
- 网络出版日期: 2025-11-17

Association between the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and severe intracranial/extracranial atherosclerotic stenosis

1.
Department of Neurology, the First Affiliated Hospital of Anhui Medical University/Anhui Public Health Clinical Center, Hefei, Anhui 230011, China

摘要

摘要: 目的探讨非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值(NHHR)和颅内/颅外动脉严重粥样硬化性狭窄之间的相关性，为颅内/颅外动脉严重狭窄高危人群早期筛查提供依据。方法纳入2018年9月—2024年12月安徽医科大学第一附属医院北区神经内科收治的286例行DSA检查的患者，依据狭窄严重程度分为严重狭窄组(狭窄≥70%或闭塞，197例)和非严重狭窄组(无狭窄或狭窄 < 70%，89例)。收集患者临床数据和血脂(总胆固醇、高密度脂蛋白胆固醇)水平，计算NHHR。采用多因素logistic回归分析评估NHHR与严重狭窄的独立关联，采用限制性立方样条分析NHHR与狭窄风险的非线性关系，通过分层分析检验关联的异质性。结果 NHHR是颅内/颅外动脉严重粥样硬化性狭窄的独立影响因素(OR=1.141，P < 0.05)。亚组分析显示这一关联在不同特征人群中稳定一致，其中58~69岁人群(OR=1.474)及颅内合并颅外狭窄患者(OR=10.122)关联更强(P < 0.05)。结论 NHHR可作为预测或评估严重动脉粥样硬化性狭窄的指标，其预测价值在58~69岁年龄组及颅内合并颅外狭窄患者中尤为突出。
- 非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值 /
- 颅内动脉 /
- 颅外动脉 /
- 动脉粥样硬化性狭窄
Abstract: Objective To investigate the correlation between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and severe atherosclerotic stenosis of intracranial/extracranial arteries. The study also seeks to provide a basis for the early screening of high-risk populations with severe intracranial/extracranial artery stenosis. Methods The present study is based on a cohort of 286 patients who underwent DSA examination in the Department of Neurology of the North District of the First Affiliated Hospital of Anhui Medical University from September 2018 to December 2024. The subjects were divided into two groups, namely the severe stenosis group (stenosis≥70% or occlusion, 197 cases) and the non-severe stenosis group (no stenosis or stenosis < 70%, 89 cases), according to the degree of stenosis. Clinical data and lipid profiles (total cholesterol and high-density lipoprotein cholesterol) were collected, and the NHHR was calculated. Multivariate logistic regression analysis was utilized to assess the independent association between NHHR and severe stenosis. Restricted cubic splines were used to analyze the nonlinear relationship between NHHR and the risk of stenosis. A stratified analysis was conducted in order to test the heterogeneity of the association. Results NHHR has been identified as an independent risk factor for severe atherosclerotic stenosis in intracranial and extracranial arteries (OR=1.141, P < 0.05). Subgroup analysis demonstrated consistent associations across different populations, with notably stronger effects observed in individuals aged 58-69 years (OR=1.474) and in patients with concurrent stenosis of both intracranial and extracranial arteries (OR=10.122, P < 0.05). Conclusion NHHR serves as a valuable indicator for predicting or evaluating severe atherosclerotic stenosis, particularly in the 58-69 age group and patients with concurrent stenosis of both intracranial and extracranial arteries.
- Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio /
- Intracranial arteries /
- Extracranial arteries /
- Atherosclerotic stenosis

HTML全文

图 1 NHHR与严重狭窄的剂量-反应关系

注：红线代表变量之间的平滑曲线拟合，蓝线代表拟合结果的95% CI。

Figure 1. Dose-response relationship between NHHR and severe stenosis

下载: 全尺寸图片幻灯片

表 1 2组颅内/颅外动脉不同狭窄程度患者临床资料比较

Table 1. Comparison of clinical data between two groups of patients with different degrees of intracranial/extracranial artery stenosis

项目	总数(n=286)	严重狭窄组(n=197)	非严重狭窄组(n=89)	统计量	P值
年龄(x ± s，岁)	64.09±10.67	65.80±10.52	60.31±10.07	4.134^b	< 0.001
性别(男/女，例)	199/87	143/54	56/33	2.707^c	0.100
高血压[例(%)]	216(75.52)	149(75.63)	67(75.28)	0.679^c	0.410
糖尿病[例(%)]	81(28.32)	57(28.93)	24(26.97)	0.117^c	0.732
吸烟[例(%)]	56(19.58)	43(21.83)	13(14.61)	2.030^c	0.154
狭窄部位[例(%)]^a				15.557^c	< 0.001
颅内	86(37.23)	67(34.01)	19(55.88)
颅外	85(36.80)	73(37.06)	12(35.29)
颅内合并颅外	60(25.97)	57(28.93)	3(8.83)
BMI(x ± s)	24.90±3.22	25.41±3.14	24.70±3.40	0.717^b	0.474
HDL-C(x ± s，mmol/L)	1.00±0.27	0.97±0.27	1.05±0.29	2.178^b	0.030
TC(x ± s，mmol/L)	4.26±1.04	4.30±1.06	4.21±1.00	0.826^b	0.410
NHHR(x ± s，mmol/L)	3.32±1.20	3.37±1.21	3.19±1.15	1.224^b	0.022
注：^a总数及非严重狭窄组包含无狭窄患者55例。^b为t值，^c为χ²值。

下载: 导出CSV

表 2 NHHR与颅内/外动脉严重狭窄关系的多因素logistic回归分析

Table 2. Multivariate logistic regression analysis of the relationship between NHHR and severe stenosis of intracranial/extracranial arteries

变量	未调整模型		模型1		模型2
变量	OR(95% CI)	P值	OR(95% CI)	P值	OR(95% CI)	P值
NHHR	1.141(0.924~1.423)	0.022	1.312(1.032~1.673)	0.025	2.218(1.349~3.628)	0.002
NHHR(三分位数)
T2	1.152(0.633~2.112)	0.644	1.342(0.713~2.528)	0.363	4.017(1.416~11.413)	0.009
T3	1.433(0.774~2.663)	0.253	2.031(1.031~3.985)	0.040	6.984(1.878~25.867)	0.004
P趋势	0.254		0.040		0.003
注：NHHR(三分位数)以T1为参照。

下载: 导出CSV

表 3 各亚组NHHR对颅内/外动脉严重狭窄的影响分层分析

Table 3. Stratified analysis of the effects of NHHR on severe intracranial/extracranial artery stenosis in each subgroup

特征	例数	OR(95% CI)	P值
年龄(岁)
33~57	88	1.081(0.761~1.505)	0.673
58~69	98	1.474(1.094~2.189)	0.049
70~88	100	1.335(0.770~2.312)	0.296
性别
男性	199	1.123(0.871~1.446)	0.380
女性	87	1.142(0.764~1.721)	0.521
高血压
否	70	1.031(0.664~1.432)	0.888
是	216	1.219(0.933~1.587)	0.146
糖尿病
否	205	1.278(0.973~1.678)	0.082
是	81	1.022(0.644~1.328)	0.657
吸烟
否	230	1.157(0.922~1.467)	0.204
是	56	1.067(0.545~1.721)	0.928
BMI
16.54~22.99	95	1.078(0.739~1.571)	0.699
23.00~25.46	95	1.044(0.692~1.589)	0.841
25.47~36.90	96	1.313(0.922~1.851)	0.131
TC(mmol/L)
1.79~3.59	95	1.778(1.043~3.373)	0.075
3.60~4.47	94	1.069(0.692~1.664)	0.776
4.48~7.60	97	1.287(0.913~1.838)	0.152
狭窄部位
颅内	86	1.243(0.783~1.971)	0.369
颅外	85	1.499(0.794~2.883)	0.218
颅内合并颅外	60	10.122(1.071~95.796)	0.044

下载: 导出CSV

参考文献(18)

[1]	LI S Y, JING J, LI J J, et al. Elevated hs-CRP and symptomatic intracranial/extracranial artery stenosis predict stroke recurrence after acute ischemic stroke or TIA[J]. J Atheroscler Thromb, 2023, 30(6): 601-610. doi: 10.5551/jat.63512
[2]	GUTIERREZ J, TURAN T N, HOH B L, et al. Intracranial atherosclerotic stenosis: risk factors, diagnosis, and treatment[J]. Lancet Neurol, 2022, 21(4): 355-368. doi: 10.1016/S1474-4422(21)00376-8
[3]	YU H X, LI H X, CUI C, et al. Association between blood microplastic levels and severity of extracranial artery stenosis[J]. J Hazard Mater, 2024, 480: 136211. DOI: 10.1016/j.jhazmat.2024.136211.
[4]	XIE Y, LIU Z X, DAN B T, et al. Associations of neutrophil-to-lymphocyte ratio with intracranial and extracranial atherosclerotic stenosis[J]. Front Neurol, 2022, 13: 966022. DOI: 10.3389/fneur.2022.966022.
[5]	GAO P, WANG T, WANG D M, et al. Effect of stenting plus medical therapy vs medical therapy alone on risk of stroke and death in patients with symptomatic intracranial stenosis: the CASSISS randomized clinical trial[J]. JAMA, 2022, 328(6): 534-542. doi: 10.1001/jama.2022.12000
[6]	WANG B X, LI L Y, TANG Y, et al. Changes in non-high-density lipoprotein to high-density lipoprotein ratio (NHHR) and cardiovascular disease: insights from CHARLS[J]. Lipids Health Dis, 2025, 24(1): 112. DOI: 10.1186/s12944-025-02536-3.
[7]	MA H X, CHEN H Q, WANG P C. Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and stroke among adults in the USA: a cross-sectional NHANES study[J]. Biomed Environ Sci, 2025, 38(1): 37-46.
[8]	LIU Z Z, LIN X M, ZENG L X, et al. Elevated non-HDL-C/HDL-C ratio increases the 1-year risk of recurrent stroke in older patients with non-disabling ischemic cerebrovascular events: results from the Xi' an Stroke Registry Study of China[J]. BMC Geriatr, 2023, 23(1): 410. DOI: 10.1186/s12877-023-04102-x.
[9]	WANG A R, LI Y P, ZHOU L, et al. Non-HDL-C/HDL-C ratio is associated with carotid plaque stability in general population: a cross-sectional study[J]. Front Neurol, 2022, 13: 875134. DOI: 10.3389/fneur.2022.875134.
[10]	QIN G M, TU J F, ZHANG C J, et al. The value of the apoB/apoAΙ ratio and the non-HDL-C/HDL-C ratio in predicting carotid atherosclerosis among Chinese individuals with metabolic syndrome: a cross-sectional study[J]. Lipids Health Dis, 2015, 14: 24. DOI: 10.1186/s12944-015-0023-4.
[11]	LIU L Q, LIU S H, LIAO Y C, et al. Association of cumulative non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with the risk of cardiometabolic disease[J]. Front Cardiovasc Med, 2024, 11: 1500025. DOI: 10.3389/fcvm.2024.1500025.
[12]	LIU M J, PEI J Y, ZENG C, et al. Association of non-high-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio with cardiovascular outcomes in patients with type 2 diabetes mellitus: evidence from the ACCORD cohort[J]. Diabetes Obes Metab, 2025, 27(1): 300-311. doi: 10.1111/dom.16018
[13]	管晶晶, 时鹏, 李保伍, 等. 颈动脉粥样硬化斑块超声联合血脂指标对心血管疾病的预测价值评估[J]. 中华全科医学, 2022, 20(8): 1376-1379. doi: 10.16766/j.cnki.issn.1674-4152.002601 GUAN J J, SHI P, LI B W, et al. Value evaluation of carotid atherosclerotic plaque ultrasound combined with blood lipid index in predicting cardiovascular disease[J]. Chinese Journal of General Practice, 2022, 20(8): 1376-1379. doi: 10.16766/j.cnki.issn.1674-4152.002601
[14]	INIA J A, VAN NIEUWKOOP-VAN STRAALEN A, JUKEMA J W, et al. Efficacy of a novel PCSK9 inhibitory peptide alone and with evinacumab in a mouse model of atherosclerosis[J]. J Lipid Res, 2025, 66(3): 100753. DOI: 10.1016/j.jlr.2025.100753.
[15]	NAMITOKOV A, KARABAKHTSIEVA K, MALYAREVSKAYA O. Inflammatory and lipid biomarkers in early atherosclerosis: a comprehensive analysis[J]. Life (Basel), 2024, 14(10): 1310. DOI: 10.3390/life14101310.
[16]	ZHANG P, JIN M Y, ZHANG L, et al. Berberine alleviates atherosclerosis by modulating autophagy and inflammation through the RAGE-NF-κB pathway[J]. Front Pharmacol, 2025, 16: 1540835. DOI: 10.3389/fphar.2025.1540835.
[17]	FU M X, LI Q M, QIAN H, et al. Exendin-4 intervention attenuates atherosclerosis severity by modulating myeloid-derived suppressor cells and inflammatory cytokines in ApoE(-/-) mice[J]. Int Immunopharmacol, 2024, 140: 112844. DOI: 10.1016/j.intimp.2024.112844.
[18]	CHANG J, LIU B, CHENG Y X, et al. Effect of repaglinide on blood glucose, endothelial function, lipid metabolism, and inflammatory reaction in a rat model of atherosclerosis[J]. Dose Response, 2020, 18(2): 710599702. DOI: 10.1177/1559325820918762.