Stroke：低密度胆固醇或为出血性卒中的保护性因素

胆固醇的水平与出血性卒中的发病风险不一致。来自上海第二军医大长征医院的同仁们使用Meta分析的方法评价胆固醇与出血性卒中间的关系，在线发表在2013年5月23日，研究结果发现：总胆固醇水平与出血性卒中的发生风险负相关。高浓度低密度胆固醇患者或可降低出血性卒中的风险，而高密度脂蛋白显示与脑出血呈正相关关系。

采用英文搜索PubMed和Embase数据库中相关的文献。纳入的标准为至少有3项不同胆固醇水平，有高浓度与低浓度的对比或每1 mmol/L胆固醇增加量对出血性卒中影响的95%可信区间。采用随机效应模型汇总研究结果。

在23项前瞻性研究中，共包含1 430 141例队列人群，其中7960 (5.6%)发生出血性卒中。在高浓度比低浓度分析中，总胆固醇对应的出血性卒中的风险为0.69 (95% CI, 0.59–0.81)，高密度胆固醇为0.98 (95% CI, 0.80–1.19)，低密度胆固醇为0.98 (95% CI, 0.80–1.19)。剂量反应相关分析中，总胆固醇每增加1 mmol/L对应出血性卒中发生风险为0.85 (95% CI, 0.80–0.91)，高密度胆固醇为1.11 (95% CI, 0.99–1.25)，低密度胆固醇为0.90 (95% CI, 0.77–1.05)。对于高密度胆固醇，合并后出血性卒中的相关危险度为1.17 (95% CI, 1.02–1.35)。

总胆固醇水平与出血性卒中的发生风险负相关。高浓度低密度胆固醇患者或可降低出血性卒中的风险，而高密度脂蛋白显示与脑出血呈正相关关系。

Cholesterol Levels and Risk of Hemorrhagic Stroke: A Systematic Review and Meta-Analysis.
BACKGROUND AND PURPOSE
Cholesterol levels are inconsistently associated with the risk of hemorrhagic stroke. The purpose of this study is to assess their relationships using a meta-analytic approach.
METHODS
We searched PubMed and Embase for pertinent articles published in English. Only prospective studies that reported effect estimates with 95% confidential intervals (CIs) of hemorrhagic stroke for ≥3 categories of cholesterol levels, for high and low comparison, or for per 1 mmol/L increment of cholesterol concentrations were included. We used the random-effects model to pool the study-specific results.
RESULTS
Twenty-three prospective studies were included, totaling 1 430 141 participants with 7960 (5.6%) hemorrhagic strokes. In high versus low analysis, the summary relative risk of hemorrhagic stroke was 0.69 (95% CI, 0.59-0.81) for total cholesterol, 0.98 (95% CI, 0.80-1.19) for high-density lipoprotein cholesterol, and 0.62 (95% CI, 0.41-0.92) for low-density lipoprotein cholesterol. In dose-response analysis, the summary relative risk of hemorrhagic stroke for 1 mmol/L increment of total cholesterol was 0.85 (95% CI, 0.80-0.91), for high-density lipoprotein cholesterol was 1.11 (95% CI, 0.99-1.25), and for low-density lipoprotein cholesterol was 0.90 (95% CI, 0.77-1.05). The pooled relative risk for intracerebral hemorrhage was 1.17 (95% CI, 1.02-1.35) for high-density lipoprotein cholesterol.
CONCLUSIONS
Total cholesterol level is inversely associated with risk of hemorrhagic stroke. Higher level of low-density lipoprotein cholesterol seems to be associated with lower risk of hemorrhagic stroke. High-density lipoprotein cholesterol level seems to be positively associated with risk of intracerebral hemorrhage.