血浆标志物与不同类型急性脑梗死的相关性研究  

Plasma Markers and Different Subtypes of Acute Cerebral Infarction: A Correlation Study

作　　者：于大林[1] 明利 唐贤勇 方顕文 永星 李惠英[1] 肖军[2] 

机构地区：[1]四川省成都市双流县第二人民医院神经内科,610213 [2]四川省人民医院神经内科

出　　处：《中国全科医学》2015年第5期516-520,共5页Chinese General Practice

基　　金：2012年四川省卫生厅科研项目(120588)

摘　　要：目的探讨血浆标志物D-二聚体(DD)、同型半胱氨酸(Hcy)、纤维蛋白原(Fib)、C反应蛋白(CRP)、红细胞沉降率(ESR)与不同类型急性脑梗死(ACI)的关系。方法选取2012年10月—2014年4月在双流县第二人民医院第1次住院治疗的ACI患者328例为研究对象,按照TOAST分型标准分为大动脉粥样硬化性脑卒中(LAA)组、小动脉闭塞性脑卒中(SAO)组、心源性脑栓塞(CE)组、不明原因的缺血性脑卒中(SUE)组。另选取同期在双流县第二人民医院体检中心健康体检者146例为对照组。收集受试者一般资料,测定血浆标志物水平,对ACI患者采用美国国立卫生研究院卒中量表(NIHSS)进行评分后计算神经功能好转率,采用改良Rankin量表(mRS)评价神经功能恢复程度。结果各组DD、Hcy、Fib、CRP和ESR比较,差异均有统计学意义(F=26.542、18.725、6.752、32.890、35.634,P<0.05)。LAA组神经功能好转率为49.8%,Fib、CRP和ESR与神经功能好转率呈负相关(rs=-0.345、-0.352、-0.348,P<0.05);CE组神经功能好转率为32.9%,DD、Fib、CRP和ESR与神经功能好转率呈负相关(rs=-0.479、-0.487、-0.481、-0.485,P<0.05)。Logistic回归显示,Hcy〔OR=2.031,95%CI(1.O41,3.051),P<0.001〕、Fib〔OR=1.680,95%CI(1.068,2.742),P<0.001〕和CRP〔OR=1.430,95%CI(1.035,2.078),P=0.012〕是LAA的危险因素,Fib〔OR=1.390,95%CI(1.016,2.352),P=0.005〕和CRP〔OR=1.920,95%CI(1.008,2.956),P<0.001〕是CE的危险因素。LAA组mRS评分≥3分患者的Fib、CRP和ESR水平高于mRS评分<3分患者,差异有统计学意义(P<0.05)。CE组评分mRS≥3分患者的DD、Fib、CRP和ESR水平高于mRS<3分患者,差异有统计学意义(P<0.05)。结论在ACI患者中,高水平的Hcy、DD有助于ACI的病因学诊断,Hcy、Fib、CRP是LAA的危险因素,Fib和CRP是CE的危险因素,不同血浆标志物均能在一定程度上反映患者预后。Objective To study the relationship of D- Dimer（ DD）,homocysteine（ Hcy）,fibrinogen（ Fib）,C- reactive protein（ CRP）, erythrocyte sedimentation rate（ ESR） to different subtypes of acute cerebral infarction（ ACI）.Methods From October 2012 to April 2014,in Second People＇s Hospital of Shuangliu Country,328 ACI patients hospitalized for the first time were divided,according to TOAST classification criteria,into groups large artery atherosclerotic stroke（ LAA）,small artery occlusive strike（ SAO）,cardiogenic cerebral embolism（ CE）,unexplained ischemic stroke（ SUE）. Another 146 healthy subjects enrolled as control group. The general information was collected,levels of plasma markers determined. NIHSS was used to calculate the improvement rate of neurological function（ NF）, modified Rankin Scale（ mRS） to evaluate the recovery of NF. Results There was significant difference in DD, Hcy, Fib, CRP, ESR among all groups（ F = 26. 542,18. 725,6. 752,32. 890,35. 634,P〈0. 05）. The improvement rate of NF of LAA group was 49. 8%,negatively correlated with Fib,CRP,ESR（ rs=- 0. 345,- 0. 352,- 0. 348,P〈0. 05）,that of group CE was 32. 9%,negatively with DD,Fib,CRP,ESR（ rs=- 0. 479,- 0. 487,- 0. 481,- 0. 485, P〈0. 05）. Logistic regression analysis showed that Hcy〔OR = 2. 031,95% CI（ 1. 041,3. 051）,P〈0. 001〕,Fib 〔OR = 1. 680,95% CI（ 1. 068,2. 742）,P〈0. 001〕,CRP〔OR = 1. 430,95% CI（ 1. 035,2. 078）,P = 0. 012〕were risk factors of LAA,that Fib 〔OR = 1. 390,95% CI（ 1. 016,2. 352）,P = 0. 005〕,CRP 〔OR = 1. 920,95% CI（ 1. 008,2. 956）,P〈0. 001 〕were risk factors of CE. In LAA group,the levels of Fib,CRP,ESR were higher in patients with mRS≥3 than in patients with mRS 3,the difference was significant（ P〈0. 05）. In CE group,DD,Fib,CRP,ESR higher in patients with mRS ≥3 than in patients with mRS 3,the difference was significant（ P〈0. 05）. Conclusion In ACI patients,high levels of Hcy,DD help diagnose the etiology of CI.Hcy,

关 键 词：脑梗死 D-二聚体 同型半胱氨酸 纤维蛋白原 C反应蛋白质 红细胞沉降率 

分 类 号：R743.33[医药卫生—神经病学与精神病学]