肥胖作为全球日益严重的公共卫生问题,与多种慢性疾病的发生密切相关,特别是与颅内动脉粥样硬化性狭窄(ICAS)的关系受到广泛关注。然而,不同肥胖评估指标与颅内动脉粥样硬化性狭窄风险的关系需进一步探讨,以及肥胖在颅内动脉粥样硬化性狭窄的具体作用机制及其干预策略仍需深入研究。文章通过系统检索并查阅国内外相关文献,从肥胖评估指标与颅内动脉粥样硬化性狭窄的关系、肥胖影响颅内动脉粥样硬化性狭窄发生与发展的潜在机制,以及颅内动脉粥样硬化性狭窄防治中肥胖相关的管理策略三个方面进行综述。Obesity, as an increasingly serious global public health issue, is closely associated with the onset of various chronic diseases, particularly intracranial atherosclerotic stenosis (ICAS), which has garnered significant attention. However, the relationship between different obesity assessment indices and the risk of ICAS warrants further investigation, as does the specific role of obesity in the pathogenesis and progression of ICAS, along with potential intervention strategies. This review systematically examines domestic and international literature to explore three key aspects: the relationship between obesity assessment indices and ICAS, the underlying mechanisms by which obesity influences the development and progression of ICAS, and the management strategies for obesity in the prevention and treatment of ICAS.
目的探讨颅内动脉粥样硬化性狭窄(ICAS)患者血清氧化型低密度脂蛋白(ox-LDL)、残余胆固醇(RC)和中性粒细胞与淋巴细胞比率(NLR)联合检测对临床预后的预测价值。方法选取2022年6月~2023年12月沧州市中心医院收治的急性脑梗死(ACI)患者,并经头部MRI及临床诊断为ICAS(观察组,n=160),根据改良Rankin量表(mRS)评分,分为预后良好组(mRS评分0~2分,n=52)和预后不良组(mRS评分≥3分,n=108);另选取同期体检健康的志愿者160例作为对照组。磁性微粒免疫层析法检测血清ox-LDL水平;收集患者临床资料,计算RC,NLR水平;Spearman法分析血清ox-LDL,RC,NLR水平与mRS评分的相关性;Logistic回归分析ICAS患者预后的影响因素;受试者工作特征(ROC)曲线分析血清ox-LDL,RC,NLR水平对ICAS患者预后的预测价值。结果与对照组相比,观察组患者血清ox-LDL(53.65±8.35 U/L vs 33.23±6.42 U/L),RC(0.82±0.15 mmol/L vs 0.52±0.13 mmol/L),NLR水平(2.84±0.38 vs 1.95±0.26)均显著升高,差异具有统计学意义(t=24.523,65.079,62.911,均P<0.05);预后不良组血清ox-LDL(57.52±8.72 U/L),RC(0.84±0.14 mmol/L),NLR水平(3.02±0.45)均高于预后良好组(45.62±6.63 U/L,0.79±0.12 mmol/L,2.48±0.36),差异具有统计学意义(t=8.699,8.507,7.562,均P<0.05);且两组患者血清TC,LDL-C,HDL-C水平及mRS评分比较,差异具有统计学意义(t=15.755~27.072,均P<0.05)。血清ox-LDL,RC,NLR水平与mRS评分均呈正相关(r=0.612,0.623,0.653,均P<0.05)。血清TC,LDL-C,HDL-C,ox-LDL,RC,NLR水平均为影响ICAS预后的因素(均P<0.05);血清ox-LDL,RC,NLR预测ICAS患者预后的AUC(95%CI)分别为0.894(0.835~0.937),0.860(0.797~0.910),0.817(0.748~0.874),三者联合预测的AUC(95%CI)为0.965(0.923~0.987),三者联合预测相比于血清ox-LDL,RC,NLR单独预测更具有价值(Z=3.030,3.969,4.839,均P<0.05)。结论ICAS患者血清ox-LDL,RC,NLR水平均上升,与mRs评分呈正相关,三者对ICAS患者预后均有预测价值,且三者联合检测的临床价值更高
