残余胆固醇在缺血性脑卒中复发中的预测价值与研究进展

The Predictive Value and Research Progress of Residual Cholesterol in Recurrent Ischemic Stroke

摘要: 缺血性脑卒中复发率高，严重影响患者预后及生活质量。尽管低密度脂蛋白胆固醇(LDL-C)控制已成为卒中二级预防的核心策略，但部分患者在LDL-C达标后仍存在较高复发风险，提示残余脂质风险的存在。残余胆固醇(residual cholesterol, RC)是指富含甘油三酯脂蛋白中的胆固醇成分，近年来被证实与动脉粥样硬化性心血管疾病密切相关，并逐渐受到脑血管领域关注。多项流行病学研究表明，RC水平升高与缺血性脑卒中的发生、不良功能结局及复发风险显著相关，且其预测价值可能独立于传统血脂指标。本文系统综述残余胆固醇的概念与检测方法，总结其在心脑血管疾病中的研究进展，重点分析其与缺血性脑卒中复发之间的关联及潜在机制，包括促进动脉粥样硬化进展、诱导炎症反应及增强血栓形成等作用。最后探讨其在卒中二级预防及风险分层管理中的应用前景，以期为复发风险评估及精准干预提供新的理论依据。

Abstract: The recurrence rate of ischemic stroke is high, which seriously affects the prognosis and quality of life of patients. Although low-density lipoprotein cholesterol (LDL-C) control has become a core strategy for secondary stroke prevention, some patients still have a high risk of recurrence even after LDL-C is met, indicating the existence of residual lipid risk. Residual cholesterol (RC) refers to the cholesterol component rich in triglyceride lipoproteins. In recent years, it has been confirmed that it is closely related to atherosclerotic cardiovascular disease, and has gradually attracted attention in the cerebrovascular field. Multiple epidemiological studies have shown that elevated levels of RC are significantly associated with the occurrence, adverse functional outcomes, and recurrence risk of ischemic stroke, and their predictive value may be independent of traditional lipid indicators. This article systematically reviews the concept and detection methods of residual cholesterol, summarizes its research progress in cardiovascular and cerebrovascular diseases, and focuses on the analysis of its association with the recurrence of ischemic stroke and its potential mechanisms, including promoting the progression of atherosclerosis, inducing inflammatory reaction, and enhancing the formation of blood clots. Finally, the application prospects of it in secondary prevention and risk stratification management of stroke are discussed, in order to provide new theoretical basis for recurrence risk assessment and precise intervention.