探讨总胆固醇(TC)、高密度脂蛋白(HDL)及总胆固醇与高密度脂蛋白比值(TC/HDL)与大脑中动脉(MCA)脉动指数(PI)的关系。

选取2014年1月至2015年12月山西医科大学第一医院神经内科住院的MCA供血区急性脑梗塞患者246例，其中女性有45例，男性有201例。记录患者的TC、HDL，采用经颅多普勒超声诊断仪探查患者双侧MCA，计算PI值。比较所有患者患侧与健侧大脑中动脉PI值，以PI值为金标准，获取TC、HDL、TC/HDL的截断值，绘制受试者操作特征(ROC)曲线。

所有患者患侧大脑中动脉PI值高于健侧(P<0.05)。TC的截断值为3.73 mmol/L，灵敏度及特异度为59%和48%；HDL的截断值为1.07 mmol/L，灵敏度及特异度为65%和42%；TC/HDL的截断值为5.74 mmol/L，灵敏度及特异度为6%和98%。TC、HDL、TC/HDL三者在ROC曲线下的面积(AUC)分别为0.466、0.516、0.502，Z检验比较AUC，差异无统计学意义(P>0.05)。

脑卒中患者大脑中动脉PI值增高，TC与脑卒中患者MCA患侧PI无相关性，HDL及TC/HDL可能是脑卒中患者大脑中动脉PI增高的独立危险因素。

To explore the relationship between total cholesterol (TC), high density lipoprotein (HDL) and total cholesterol/high density lipoprotein(TC/HDL) with pulsatility index (PI) of middle cerebral artery (MCA).

A total of 246 patients with acute ischemic stroke in the middle cerebral artery were slected in Department of Internal Neurology of the First Hospital of Shanxi Medical University from Janurary 2014 to December 2015, including 45 femala patients and 201 male patients. TC and HDL of ischemic stroke were collected, PI of middle cerebral artery was detected and calculated by transcranial Doppler. PI of middle cerebral artery was compared between suffering side and healthy side, best cutoff value of TC、HDL、TC/HDL was obtained and receiver operating characteristic(ROC)curve was analyzed based on gold standard of PI value.

PI of MCA of suffering side was statistically significantly higher than that of healthy side(P<0.05) .The best cutoff value of TC was 3.73 mmol/L, and its corresponding sensitivity and specificity were 59% and 48%; The best cutoff value of HDL was 1.07 mmol/L, and its corresponding sensitivity and specificity were 65% and 42%; The best cutoff value of TC/HDL was 5.74 mmol/L, and its corresponding sensitivity and specificity were 6% and 98%.The areas under the ROC curve (AUC) of TC、HDL and TC/HDL diagnosis of PI value were 0.466、0.516 and 0.502.There were not statistical differences between the three indexs in terms of AUC(P>0.05).

PI of MCA is increased in patients with ischemic stroke.TC has no relation with increased PI of suffering side of MCA.HDL and TC/HDL may be independent risk factors of increased PI of MCA.