目的：探讨高密度脂蛋白胆固醇（HDL-C）与症状性颅内动脉粥样硬化性狭窄（ICAS）患者低灌注的 相关性。方法：回顾性分析2017年1月至2022年12月就诊于鄂尔多斯市中心医院神经内科接受血管内介 入治疗的症状性单侧颈内动脉C4-7段或大脑中动脉M1段狭窄（50%～99%）导致的缺血性卒中患者的临床 资料，根据其计算机断层扫描灌注（CTP）成像将患者分为低灌注组（半暗带体积≥15 mL）和非低灌注组 （半暗带体积＜15 mL）。比较2组间临床资料的差异，单因素显著的指标进入多因素二元logistics回归分 析，多因素显著的指标进行ROC曲线分析。结果：共纳入患者120例，其中48例（40%）存在CTP低灌注；组间 差异分析显示CTP非低灌注组的侧支循环分级明显优于低灌注组（P＜0.05），低灌注组的HDL-C水平显著低 于非低灌注组（P＜0.05），多因素logistics回归分析表明HDL-C降低是症状性ICAS患者脑组织低灌注的独立 危险因素（OR=0.021，P=0.035，95%CI 0.001～0.756），最佳临界值为1.02 mmol/L，此时ROC曲线下面积达 到0.759，P＜0.05，敏感度为91.67%，特异度为55.56%，95%CI为0.569～0.896。结论：症状性ICAS患者CTP 低灌注组的HDL-C显著低于非低灌注组，HDL-C降低是症状性ICAS患者脑组织低灌注的独立危险因素。

To investigate the correlation between high-density lipoprotein cholesterol (HDL-C) and cerebral tissue hypoperfusion in patients with symptomatic intracranial atherosclerotic stenosis (ICAS). Methods: A retrospective analysis was conducted on the clinical data of patients who received endovascular intervention for ischemic stroke caused by symptomatic unilateral internal carotid artery C4-7 segment or middle cerebral artery M1 segment stenosis (50%-99% ) at the Department of Neurology, Ordos City Central Hospital from January 2017 to December 2022. Patients were divided into a low perfusion group (penumbra volume ≥ 15 mL) and a non-low perfusion group (penumbra volume <15 mL) based on their computed tomography perfusion (CTP) imaging. Differences in clinical data between the two groups were compared, and significant indicators from univariate analysis were entered into multivariate binary logistic regression analysis. Significant indicators from the multivariate analysis were subjected to ROC curve analysis. Results: A total of 120 patients were included, of whom 48 (40%) had CTP low perfusion; intergroup difference analysis showed that the collateral circulation grade of the non-low perfusion group was significantly better than that of the low perfusion group (P<0.05), and the HDL-C level of the low perfusion group was significantly lower than that of the non-low perfusion group (P<0.05). Multivariate logistic regression analysis indicated that reduced HDL-C was an independent risk factor for cerebral tissue hypoperfusion in patients with symptomatic ICAS (OR=0.021, P= 0.035, 95%CI 0.001～0.756), with an optimal cutoff value of 1.02 mmol/L. At this point, the area under the ROC curve reached 0.759, P<0.05, sensitivity was 91.67%, specificity was 55.56%, and 95%CI was 0.569～ 0.896. Conclusion: The HDL-C level of the low perfusion group in patients with symptomatic ICAS was significantly lower than that of the non-low perfusion group, and reduced HDL-C was an independent risk factor for cerebral tissue hypoperfusion in patients with symptomatic ICAS.