不同TOAST亚型老年急性脑梗死患者血清髓鞘碱性蛋白水平变化及其临床意义  

The clinical senses of myelin basic protein in old patient with different TOAST subtypes of acutecerebral infarct

作　　者：陈应柱 刘刚[1] 杨璞 朱艳 杨德刚 黄金忠 包仕尧[2] 

机构地区：[1]扬州大学临床医学院神经内科,江苏扬州225001 [2]苏州大学附属第二医院

出　　处：《中国急救医学》2012年第4期291-294,共4页Chinese Journal of Critical Care Medicine

基　　金：江苏省中医药管理局课题（No.LB09126）

摘　　要：目的观察不同类型老年急性脑梗死（ACI）患者血清髓鞘碱性蛋白（MBP）变化与美国国立卫生研究院卒中量表（NIHSS）评分的关系。方法采用ELISA法检测328例住院老年ACI患者血清MBP含量，并按照急性卒中治疗低分子肝素试验（TOAST）分型标准分为5大亚型，分析TOAST各亚型血清MBP含量变化及NIHSS评分的相关性。结果本组TOAST各亚型构成比：大动脉粥样硬化型（IJAA）42．99％、小动脉闭塞型（SAO）21．95％、心源性栓塞型（CE）15．85％、不明原因型（SUE）15．55％及其他明确病因型（SDE）3．66％；CE、LAA、SUE血清MBP含量升高，SAO变化不明显，与对照组比较，LAA、CE差异有统计学意义（P〈0．01）；血清MBP含量与TC、TG、LDL—C、SBP、DBP和年龄呈正相关，与HDL呈负相关；血清MBP含量在LAA、SUE亚型与相应NIHSS评分具有相关性（r=0．68、0．51），在CE、SAO亚型中相关性较差。结论血清MBP含量随TOAST亚型的不同而变化。LAA、SUE亚型的缺血性卒中患者在发病后血清MBP含量可以作为病情、预后判断的一个参考依据。Objective To investigate pattern of fluctuations and clinical significance of myelin basic protein （MBP） levels in old patient with different subtypes of acute cerebral infarct and its relationship with the score of American National Institutes of Health stroke scale （NIHSS） score. Methods MBP was measured in 328 old ACI patients by ELISA. All old AC1 patients were classified into 5 groups based on the Trial of Org 10172 in Acute Stroke Treatment （TOAST） criteria. And then the relationship between MBP level and NIHSS score in different TOAST subtypes were analysed. Results The percentage of each isehemic stroke TOAST subtype was as follow： large - artery atherosclerosis 42. 99% , small - vessel occlusion 21. 95% , cardioembolism 15. 85% , stroke of undetermined etiology 15.55% , stroke of other determined etiology 3.66%. The serum level of MBP in cardioembolism, large - artery atherosclerosis and stroke of undetermined etiology subtypes increased after cerebral infarct. The serum level of MBP of small - vessel occlusion subtype hash It significantly changed in TOAST. Compared to the SVO group, the serum level of MBP in LAA and CE have significant difference（P 〈0.01 ）. There was a positive correlation in LAA and SUE groups（ r = 0.68, 0. 51, P 〈 0, 05 ） and there was a negative correlation in CE and SAO groups. Apparently, other factors, such as TC, TG, LDL - C, SBP, DBP, age and HDL - C, could ＂also affect the level of MBP. Conclusion Different classifications have different serum level of MBP. there was a positive correlation between MBP and NIHSS score in some subtypes. The serum level of MBP is related to the severity of the state of cerebral infarction to some degree.

关 键 词：急性脑梗死(ACI) 急性卒中治疗低分子肝素试验(TOAST) 髓鞘碱性蛋白 (MBP) 美国国立卫生研究所卒中量表(NIHSS)评分 

分 类 号：R743.31[医药卫生—神经病学与精神病学]