刘晓宇;李春;王晓放;张怡琳;田雨;赵莘瑜;

• 1:郑州大学第一附属医院

摘要(Abstract)：

目的探讨吉兰-巴雷综合征(GBS)患者急性期血脂水平与疾病严重程度的相关性。方法回顾性分析2016-01―2019-07于郑州大学第一附属医院神经内科住院的110例GBS患者的临床资料,实验室检查指标包括血脂、血糖、血清白蛋白及脑脊液总蛋白水平。根据病情达峰时Hughes功能评级量表评分,将GBS患者分为轻型组和重型组,比较2组间指标差异,并通过多因素Logistic回归模型进一步分析血脂水平与GBS疾病严重程度的相关性。结果重型GBS组血低密度脂蛋白胆固醇水平较轻型GBS组更低(2.32 vs 2.68,P=0.011)。在多因素Logistic回归模型中进一步调整年龄、血清白蛋白、脑脊液总蛋白水平后,血低密度脂蛋白胆固醇水平与GBS疾病严重程度显著相关(OR 0.421,95%CI 0.216～0.821,P=0.011)。结论 GBS患者急性期低水平血低密度脂蛋白胆固醇与重型GBS发生风险增加相关,合并心脑血管疾病的GBS急性期患者应用他汀类药物对疾病进展的影响值得进一步探究。

关键词(KeyWords)： 吉兰-巴雷综合征;血脂代谢;低密度脂蛋白胆固醇;年龄;疾病严重程度

Abstract:

Keywords:

基金项目(Foundation): 河南省医学科技攻关计划项目(编号:2018010008)

作者(Authors): 刘晓宇;李春;王晓放;张怡琳;田雨;赵莘瑜;

参考文献(References)：

• [1] LEONHARD S E,MANDARAKAS M R,GONDIM F A A,et al.Diagnosis and management of Guillain-Barré syndrome in ten steps[J].Nat Rev Neurol,2019,15(11):671-683.
• [2] WU X,LI C,ZHANG B,et al.Predictors for mechanical ventilation and short-term prognosis in patients with Guillain-Barré syndrome[J].Crit Care,2015,19(1):310.
• [3] HUSSAIN G,WANG J,RASUL A,et al.Role of cholesterol and sphingolipids in brain development and neurological diseases[J].Lipids Health Dis,2019,18(1):26.
• [4] ROBINSON G A,WADDINGTON K E,PINEDA-TORRA I,et al.Transcriptional Regulation of T-Cell Lipid Metabolism:Implications for Plasma Membrane Lipid Rafts and T-Cell Function[J].Front Immunol,2017,8:1636.
• [5] URQUIZU-PADILLA M,BALADA E,CHACON P,et al.Changes in lipid profile between flare and remission of patients with systemic lupus erythematosus:a prospective study[J].J Rheumatol,2009,36(8):1639-1645.
• [6] ZHORNITSKY S,MCKAY K A,METZ LM,et al.Cholesterol and markers of cholesterol turnover in multiple sclerosis:relationship with disease outcomes[J].Mult Scler Relat Disord,2016,5:53-65.
• [7] LEI Y,YANG J,LI H,et al.Changes in glucose-lipid metabolism,insulin resistance,and inflammatory factors in patients with autoimmune thyroid disease[J].J Clin Lab Anal,2019,33(7):e22929.
• [8] 祝广林,齐鸿飞,曲良锁.1例脑出血患者住院治疗期间突发吉兰-巴雷综合征[J].中国实用神经疾病杂志,2018,21(8):909-911.
• [9] HUGHES R A,NEWSOM-DAVIS J M,PERKIN G D,et al.Controlled trial prednisolone in acute polyneuropathy[J].Lancet,1978,2(8093):750-753.
• [10] TANG H Y,CHIU D T,LIN J F,et al.Disturbance of Plasma Lipid Metabolic Profile in Guillain-Barre Syndrome[J].Sci Rep,2017,7(1):8140.
• [11] SAHER G,SIMONS M.Cholesterol and myelin biogenesis[J].Subcell Biochem,2010,51:489-508.
• [12] DO H T,BRUELLE C,PHAM D D,et al.Nerve growth factor (NGF) and pro-NGF increase low-density lipoprotein (LDL) receptors in neuronal cells partly by different mechanisms:role of LDL in neurite outgrowth[J].J Neurochem,2016,136(2):306-315.
• [13] NAQVI S S Z H,IMANI S,HOSSEINIFARD H,et al.Associations of serum low-density lipoprotein and systolic blood pressure levels with type 2 diabetic patients with and without peripheral neuropathy:systemic review,meta-analysis and meta-regression analysis of observational studies[J].BMC Endocr Disord,2019,19(1):125.
• [14] BANG O Y,SAVER J L,LIEBESKIND D S,et al.Cholesterol level and symptomatic hemorrhagic transformation after ischemic stroke thrombolysis[J].Neurology,2007,68(10):737-742.
• [15] YUAN T,CHEN N,JIN H,et al.Increased microvascular permeability and low level of low-density lipoprotein cholesterol predict symptomatic intracerebral hemorrhage in acute ischemic stroke[J].Sci Prog,2020,103(2):36850420924153.
• [16] EMANUELSSON F,NORDESTGAARD B G,TYBJ?RG-HANSEN A,et al.Impact of LDL Cholesterol on Microvascular Versus Macrovascular Disease:A Mendelian Randomization Study[J].J Am Coll Cardiol,2019,74(11):1465-1476.
• [17] STANCU C S,TOMA L,SIMA A V.Dual role of lipoproteins in endothelial cell dysfunction in atherosclerosis[J].Cell Tissue Res,2012,349(2):433-446.
• [18] THRIFT A,MCNEIL J,DONNAN G.Melbourne Risk Factor Study Group.Reduced frequency of high cholesterol levels among patients with intracerebral haemorrhage[J].J Clin Neurosci,2002,9(4):376-380.
• [19] OONEDA G,YOSHIDA Y,SUZUKI K,et al.Smooth muscle cells in the development of plasmatic arterionecrosis,arteriosclerosis,and arterial contraction[J].Blood Vessels,1978,15(1/3):148-156.
• [20] LEVELS J H,PAJKRT D,SCHULTZ M,et al.Alterations in lipoprotein homeostasis during human experimental endotoxemia and clinical sepsis[J].Biochim Biophys Acta,2007,1771(12):1429-1438.
• [21] GONZáLEZ-GAY M A,GONZáLEZ-JUANATEY C.Inflammation and lipid profile in rheumatoid arthritis:bridging an apparent paradox[J].Ann Rheum Dis,2014,73(7):1281-1283.
• [22] TWIG G,LIVNEH A,VIVANTE A,et al.Cardiovascular and metabolic risk factors in inherited autoinflammation[J].J Clin Endocrinol Metab,2014,99(10):E2123-E2128.
• [23] HUDGINS L C,PARKER T S,LEVINE D M,et al.A single intravenous dose of endotoxin rapidly alters serum lipoproteins and lipid transfer proteins in normal volunteers[J].J Lipid Res,2003,44(8):1489-1498.
• [24] YE Q,LEI H,FAN Z,et al.Difference in LDL receptor feedback regulation in macrophages and vascular smooth muscle cells:foam cell transformation under inflammatory stress[J].Inflammation,2014,37(2):555-565.
• [25] YE Q,CHEN Y,LEI H,et al.Inflammatory stress increases unmodified LDL uptake via LDL receptor:an alternative pathway for macrophage foam-cell formation[J].Inflamm Res,2009,58(11):809-818.
• [26] LIU S,XIAO Z,LOU M,et al.Guillain-Barré syndrome in southern China:retrospective analysis of hospitalised patients from 14 provinces in the area south of the Huaihe River[J].J Neurol Neurosurg Psychiatry,2018,89(6):618-626.
• [27] WEAVING G,BATSTONE G F,JONES R G.Age and sex variation in serum albumin concentration:an observational study[J].Ann Clin Biochem,2016,53(Pt 1):106-111.
• [28] BROOKS J A,MCCUDDEN C,BREINER A,et al.Causes of albuminocytological dissociation and the impact of age-adjusted cerebrospinal fluid protein reference intervals:a retrospective chart review of 2627 samples collected at tertiary care centre[J].BMJ Open,2019,9(2):e025348.
• [29] MAMOSHINA P,KOCHETOV K,PUTIN E,et al.Population Specific Biomarkers of Human Aging:A Big Data Study Using South Korean,Canadian,and Eastern European Patient Populations[J].J Gerontol A Biol Sci Med Sci,2018,73(11):1482-1490.
• [30] SOETERS P B,WOLFE R R,SHENKIN A.Hypoalbuminemia:Pathogenesis and Clinical Significance[J].JPEN J Parenter Enteral Nutr,2019,43(2):181-193.
• [31] YAO X Y,WU Y F,GAO M C,et al.Serum albumin level is associated with the severity of neurological dysfunction of NMOSD patients[J].Mult Scler Relat Disord,2020,43:102130.
• [32] DEVECI B,GAZI E.Relation Between Globulin,Fibrinogen,and Albumin With the Presence and Severity of Coronary Artery Disease[J].Angiology,2020,30:3319720959985.
• [33] MIYAZAKI H,NAGATA N,AKAGI T,et al.Comprehensive analysis of prognostic factors in hospitalized patients with pneumonia occurring outside hospital:Serum albumin is not less important than pneumonia severity assessment scale[J].J Infect Chemother,2018,24(8):602-609.
• [34] BREINER A,MOHER D,BROOKS J,et al.Adult CSF total protein upper reference limits should be age-partitioned and significantly higher than 0.45 g/L:a systematic review[J].J Neurol,2019,266(3):616-624.
• [35] BLENNOW K,FREDMAN P,WALLIN A,et al.Protein analysis in cerebrospinal fluid.II.Reference values derived from healthy individuals 18-88 years of age[J].Eur Neurol,1993,33(2):129-133.
• [36] CASTELLAZZI M,MOROTTI A,TAMBORINO C,et al.Increased age and male sex are independently associated with higher frequency of blood-cerebrospinal fluid barrier dysfunction using the albumin quotient[J].Fluids Barriers CNS,2020,17(1):14.