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혈청 중성 지방과 급성 허혈성 뇌경색의조기 예후와의 관계

Association Between Serum Triglyceride Level and Early Prognosis of Acute Ischemic Stroke

박만석|강경욱|김준태|최성민|이승한|김병채|김명규|조기현|최강호
대한신경과학회 (Korean Neurological Association)|2008.05|대한신경과학회지 (Journal of the Korean Neurological Association)|제26권 제2호|pp. 95-103

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참고문헌

키워드

StrokeTriglyceridePrognosisCholesterol
주제분류신경과학

초록

Background: Although the association between serum cholesterol levels and cerebrovascular disorder has been extensively studied, the relationship between cholesterol levels and outcome following ischemic stroke remains to be established. We evaluated the association between serum triglyceride levels and the early prognosis of acute ischemic stroke. Methods: Among 1096 patients who were admitted to the Neurology department of Chonnam National University Hospital from June 2005 to April 2007, 598 consecutive patients with acute ischemic stroke were enrolled in this study. Patients were divided into five groups based on serum triglyceride levels. Results: The level of triglyceride was significantly lower in patients with 4 or more improvement in NIHSS score than in patients without improvement (100.4 versus 135.0 mg/dl, p<0.001). In a univariate analysis, thrombolytic therapy (p<0.001), atrial fibrillation (p<0.001), lower total cholesterol (p=0.001), lower LDL cholesterol (p=0.019) and previous statin therapy (p=0.042) were also associated with a better functional outcome. After adjustment for known confounding variables, multivariate and survival analysis showed that a lower triglyceride level above the normal range remained an independent predictor of better functional outcome (p=0.002). Previous statin therapy and thrombolytic therapy were also independent predictors for better functional outcome (p=0.044;p<0.001). However, extremely low triglyceride level (<50.0 mg/dl) was associated with poor functional outcome after an acute ischemic stroke. Conclusions: These results suggest that serum triglyceride measurements in acute ischemic stroke could be helpful in predicting clinical improvement. Further prospective studies are required to determine whether triglyceride is an independent predictor for better functional outcome.

Abstract

Background: Although the association between serum cholesterol levels and cerebrovascular disorder has been extensively studied, the relationship between cholesterol levels and outcome following ischemic stroke remains to be established. We evaluated the association between serum triglyceride levels and the early prognosis of acute ischemic stroke. Methods: Among 1096 patients who were admitted to the Neurology department of Chonnam National University Hospital from June 2005 to April 2007, 598 consecutive patients with acute ischemic stroke were enrolled in this study. Patients were divided into five groups based on serum triglyceride levels. Results: The level of triglyceride was significantly lower in patients with 4 or more improvement in NIHSS score than in patients without improvement (100.4 versus 135.0 mg/dl, p<0.001). In a univariate analysis, thrombolytic therapy (p<0.001), atrial fibrillation (p<0.001), lower total cholesterol (p=0.001), lower LDL cholesterol (p=0.019) and previous statin therapy (p=0.042) were also associated with a better functional outcome. After adjustment for known confounding variables, multivariate and survival analysis showed that a lower triglyceride level above the normal range remained an independent predictor of better functional outcome (p=0.002). Previous statin therapy and thrombolytic therapy were also independent predictors for better functional outcome (p=0.044;p<0.001). However, extremely low triglyceride level (<50.0 mg/dl) was associated with poor functional outcome after an acute ischemic stroke. Conclusions: These results suggest that serum triglyceride measurements in acute ischemic stroke could be helpful in predicting clinical improvement. Further prospective studies are required to determine whether triglyceride is an independent predictor for better functional outcome.

참고문헌 (35)

  1. Hollander M, "Incidence, risk, and case fatality of first ever stroke in the elderly population: the Rotterdam Study", J Neurol Neurosurg Psychiatry, 74, pp.317~321 (2003)
  2. Sacco RL, "Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community; the Northern Manhattan Stroke Study", Neurology, 44, pp.626~634 (1994)
  3. Benfante R, "Elevated serum cholesterol is a risk factor for both coronary heart disease and thromboembolic stroke in Hawaiian Japanese men. Implications of shared risk", Stroke, 25, pp.814~820 (1994)
  4. Iso H, "Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial", N Engl J Med, 320, pp.904~910 (1989)
  5. Matthias Endres, "Statins and stroke", J Cereb Blood Flow Metab, 25, pp.1093~1110 (2005)
  6. Vauthey C, "Better outcome after stroke with higher serum cholesterol levels", Neurology, 54, pp.1944~1949 (2000)
  7. Zuliani G, "Low cholesterol levels are associated with short-term mortality in older patients with ischemic stroke", J geront A Biol Sci Med Sci, 59, pp.293~297 (2004)
  8. Pikija S, "Higher serum triglyceride level in patients with acute ischemic stroke is associated with lower infarct volume on CT brain scans", Eur Neurol, 55, pp.89~92 (2006)
  9. Dziedzic T, "Lower serum triglyceride level is associated with increased stroke severity", Stroke, 35, pp.151~152 (2004)
  10. Weir CJ, "Low Triglyceride, not low cholesterol concentration, Independently predicts poor outcome following acute stroke", Cerebrovasc Dis, 16, pp.76~82 (2003)
  11. Lernfelt B, "Cerebral atherosclerosis as predictor of stroke and mortality in representative elderly population", Stroke, 33, pp.224~229 (2002)
  12. Marti-Fàbregas J, "Favorable outcome of ischemic stroke in patients pretreated with statins", Stroke, 35, pp.1117~1123 (2004)
  13. Elkind MS, "Lipid-lowering agent use at ischemic stroke onset is associated with decreased mortality", Neurology, 65, pp.253~258 (2005)
  14. Butterworth RJ, "Changes in serum lipid measurements following acute ischaemic stroke", Cerebrovasc Dis, 7, pp.10~13 (1997)
  15. Aull S, "Dynamic changes of plasma lipids and lipoproteins in patients after transient ischemic attack or minor stroke", Am J Med, 101, pp.291~298 (1996)
  16. Kargman DE, "Lipid and lipoprotein levels remain stable in acute ischemic stroke: the Northern Manhattan Stroke Study", Atherosclerosis, 139, pp.391~399 (1998)
  17. Woo J, "Acute and long-term changes in serum lipids after acute stroke", Stroke, 21, pp.1407~1411 (1990)
  18. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP), "Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III)", JAMA, 285, pp.2486~2497 (2001)
  19. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group, "Tissue plasminogen activator for acute ischaemic stroke", N Engl J Med, 333, pp.1581~1587 (1995)
  20. Abbott RD, "Changes in total and high density lipoprotein cholesterol over 10 and 20 year period", Am J Cardiol, 82, pp.172~178 (1998)
  21. Sacco RL, "Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack", Stroke, 37, pp.577~617 (2006)
  22. Adams HP Jr, "Guidelines for the early management of patients with ischemic stroke", Stroke, 34, pp.1056~1083 (2003)
  23. Furlan A, "Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial", JAMA, 282, pp.2003~2011 (1999)
  24. Adams HP Jr, "Classification of subtype of acute ischemic stroke Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment", Stroke, 24, pp.35~41 (1993)
  25. Ois A, "Early arterial study in the prediction of mortality after acute ischemic stroke", Stroke, 38, pp.2085~2089 (2007)
  26. Kitayama J, "Cerebral vascular dysfunction during hypercholesterolemia", Stroke, 38, pp.2136~2141 (2007)
  27. Bradley WA, "Thrombin", prothrombin interactions with very low density lipoproteins, 1986, pp.485, 159~169
  28. Denning GM, "Role of triglycerides in endothelial cell arachidonic acid metabolism", J Lipid Res, 24, pp.993~1001 (1983)
  29. Saltiel AR, "Insulin signalling and the regulation of glucose and lipid metabolism", Nature, 414, pp.799~806 (2001)
  30. Paolino AS, "Effects of hyperglycemia on neurologic outcome in stroke patients", J Neurosci Nurs, 37, pp.130~135 (2005)
  31. Bakker SJ, "Cytosolic triglycerides and oxidative stress in central obesity: the missing link between excessive atherosclerosis, endothelial dysfunction, and b-cell failure", Atherosclerosis, 148, pp.17~21 (2000)
  32. Eryurek FG, "Gamma- glutamyl transpeptidase and acetylcholinesterase activities in brain capillaries of cholesterol-fed rabbits", Res Commun Chem Pathol Pharmacol, 69, pp.245~248 (1990)
  33. FOOD Trial Collaboration, "Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial", Stroke, 34, pp.1450~1456 (2003)
  34. Bang OY, "Cholesterol level and symptomatic hemorrhagic transformation after ischemic stroke thrombolysis", Neurology, 68, pp.737~742 (2007)
  35. Henon H, "Early predictors of death and disability after acute cerebral ischemic event", Stroke, 26, pp.392~398 (1995)

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