脑梗死患者急性期血清泛素羧基末端水解酶-1及神经胶质原纤维酸性蛋白水平的变化  

Changes of ubiquitin C-terminal hydrolase-L1 and glial fibrillary acidic protein levels in acute phase of cerebral infarction

作　　者：李娜[1] 任长虹[2] 吉训明[2] 

机构地区：[1]北京市仁和医院神经内科,102600 [2]首都医科大学宣武医院低氧医学研究所

出　　处：《中国脑血管病杂志》2016年第7期337-342,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(81171241;81573867);北京市优秀人才D类资助项目(20r10005018000007)

摘　　要：目的探讨泛素羧基末端水解酶-1（UCH-L1）、神经胶质原纤维酸性蛋白（GFAP）在脑梗死急性期水平的变化。方法回顾性纳入2011年3月至2012年6月于首都医科大学宣武医院神经内科门诊、急诊和卒中筛查工程基地及北京市仁和医院神经内科病房就诊的早期脑梗死患者95例作为脑梗死组,并选择同期在体检中心接受体检的61名非卒中对象作为对照组。测定脑梗死组及脑梗死发病不同时间组（发病〈12 h组和发病12-24 h组）及美国国立卫生研究院卒中量表（NIHSS）不同评分组（NIHSS 0-4分组和NIHSS 5-19分组）和对照组人群的血清UCH-L1、GFAP水平并进行各组间比较。构建受试者工作特征（ROC）曲线,获取相关参数在脑梗死诊断中的阳性与阴性的临界值及诊断敏感度与特异度。结果脑梗死组血清UCH-L1、GFAP均高于对照组[0.13（0.09,0.21）μg/L比0.05（0.02,0.13）μg/L,0.030（0.008,0.130）μg/L比0.004（0.004,0.020）μg/L;Z值分别为3.62、4.95,均P〈0.01];NIHSS评分5-19分组血清UCH-L1、GFAP水平高于NIHSS评分0-4分组[0.12（0.08,0.21）比0.09（0.08,0.18）,0.07（0.01,0.11）比0.04（0.01,0.10）;均P〈0.05]。发病12-24 h组血清UCH-L1、GFAP水平与发病〈12 h组差异无统计学意义[0.12（0.08,0.21）μg/L比0.09（0.08,0.18）μg/L,0.030（0.010,0.110）μg/L比0.040（0.008,0.100）μg/L;均P〉0.05]。UCH-L1、GFAP诊断急性脑梗死的ROC曲线分析结果显示,当血清UCH-L1≥0.18μg/L时,UCH-L1的敏感度、特异度分别为68%、74%;当血清GFAP≥0.11μg/L时,GFAP的敏感度和特异度分别为70%、86%;UCH-L1、GFAP诊断脑梗死的ROC曲线下面积分别为0.64及0.71。结论血清UCH-L1、GFAP水平在脑梗死急性期时有明显变化。血清UCH-L1、GFAP水平与卒中的严重程度可能具有一定相关性。Objective To investigate the changes of ubiquitin C-terminal hydrolase-L1 （ UCH-L1 ） and glial fibrillary acidic protein （GFAP） in acute phase of cerebral infarction. Methods From March 2011 to June 2012,95 patients with early cerebral infarction from the Neurology Clinic, the Emergency Department and the Cerebral Apoplexy Screening Project Base, and the Neurology Ward of Renhe Hospital were used as an infarction group;61 non-stroke subjects received physical examination in the Physical Examination Center of our hospital in the same period were used as a control group. The cerebral infarction group and the patients with cerebral infarction in different onset of time groups （an onset 〈 12 h group and an onset 12-24 h group）,the different National Institutes of Health Stroke Scale （NIHSS） score groups （ NIHSS 0 -4 group and NIHSS 5 - 19 group）, and the levels of UCH-L1 and GFAP in the control groupwere measured and compared among the groups. The receiver operating characteristic （ ROC ） curve was established. The cut-off values of the relevant parameters in the diagnosis of cerebral infarction, and the sensitivity and specificity of diagnosis were obtained. Results The UCH-L1 and GFAP values of the cerebral infarction group were all higher than those of the normal control group （0. 1310.09,0.21 ] μg/L vs. 0. 05 [ 0. 02,0.13 ] μg/L, 0. 030 [ 0.008,0. 130 ] μg/L vs. 0. 004 [ 0. 004,0.020 ]μg/L, Z values were 3.62 and 4.95 respectively;all P 〈0. 01 ）. The UCH-L1 and GFAP values of the NIHSS score 5 -19 group were higher than those of the NIHSS score 0 -4 group （0. 12 [ 0.08, 0. 21 ] vs. 0. 09 [ 0.08,0.18 ], 0.07 [ 0. 01,0.11 ] vs. 0. 04 [ 0.01,0.10 ] ; all P 〈 0. 05 ）. There was no significant difference in the UCH-L1 and GFAP values between the onset 12 -24 h group and the onset 〈 12 h group （0.12 [ 0.08,0.21 ] μg/L vs. 0.09[0.08,0.18 ] μg/L,0.030[0.010,0.110] μg/L vs. 0. 040[0.008,0. 100] μg/L; all P 〉 0.05）. The analysis results of ROC curve of UCH-L1 and GFAP f

关 键 词：脑梗死 泛素羧基末端水解酶-1 神经胶质原纤维酸性蛋白 

分 类 号：R743.3[医药卫生—神经病学与精神病学]