大面积脑梗死患者血浆脂代谢、凝血功能指标与神经功能缺损程度及预后的关系  

The association of plasma lipid metabolism levels,coagulation function indexes and neurological deficit degree with prognosis in patients with massive cerebral infarction

作　　者：黄顺贵[1] 刘梅[1] 王彬[1] 钟晓闵[1] 宋春江[1] HUANG Shun-gui;LIU Mei;WANG Bin;ZHONG Xiao-min;SONG Chun-jiang(Department of Neurology,Chengdu Sixth People's Hospital,Chengdu 610051,China)

机构地区：[1]成都市第六人民医院神经内科

出　　处：《实用医院临床杂志》2019年第5期53-56,共4页Practical Journal of Clinical Medicine

摘　　要：目的探讨大面积脑梗死患者血浆检测指标与神经功能缺损的关系及预测预后效果的临床价值。方法94例大面积脑梗死患者,参考入院时美国国立卫生研究院卒中量表(NIHSS)评分结果分为中度缺损组(NIHSS为5~15分,n=42)与重度缺损组(NIHSS>15分,n=52);按照起病后30d改良Rankin量表(mRS)评分结果分为预后良好组(mRS为0~3分,n=50)与预后不良组(mRS为4~6分,n=44)。分别比较同一分组标准下,两组患者血浆脂代谢指标水平差异,采用Pearson相关系数模型,分析上述血浆检测指标与NIHSS、mRS评分的相关性,以受试者工作特征(ROC)曲线分析各指标预测患者预后效果的价值。结果中度缺损组血浆Lp(a)、ox-LDL、FIB、D-Dimer水平明显低于重度缺损组,预后良好组血浆Lp(a)、ox-LDL、FIB、D-Dimer水平明显低于预后不良组(P<0.05)。血浆Lp(a)、ox-LDL、FIB、D-Dimer水平与NIHSS、mRS评分均呈显著正相关性(P<0.05)。血浆Lp(a)、ox-LDL、FIB、D-Dimer预测预后的ROC曲线AUC分别为0.735、0.720、0.690、0.680,Cut-off值分别为335.50 mg/L、645.54 ng/ml、4.51 g/L、378.58 ng/ml。结论血浆脂代谢、凝血功能指标与大面积脑梗死患者神经功能缺损程度、预后关系较为紧密,临床检测能为治疗措施及预后评估提供有价值的证据。Objective To explore the relationship between plasma detection indexes and neurological deficit and their clinical value of predicting prognosis in patients with massive cerebral infarction.Methods Ninety-four patients with massive cerebral infarction were classified into moderate deficit group(5~15 points of NIHSS,n=42)and severe deficit group(NIHSS>15 points,n=52)according to the National Institutes of Health Stroke Scale(NIHSS)score at admission.According to the modified Rankin scale(mRS)score on the 30 th day after onset,the patients were divided into good prognosis group(0~3 points of mRS,n=50)and poor prognosis group(4~6 points of mRS,n=44).Under the same grouping criteria,the levels of plasma lipid metabolism indexes and coagulation function indexes were compared between the two groups.Pearson correlation coefficient model was used to analyze the correlation between the plasma detection indexes and scores of NIHSS and mRS.The value of each index in predicting prognosis was analyzed by receiver operating characteristic curve(ROC)analysis.Resplts The levels of plasma Lp(a),ox-LDL,FIB and D-Dimer in the moderate deficit group were significantly lower than those in the severe deficit group,and the levels of the indexes above in the good prognosis group were significantly lower than those in the poor prognosis group(P<0.05).Levels of plasma Lp(a),ox-LDL,FIB and D-Dimer were significantly positively correlated with scores of NIHSS and mRS(P<0.05).ROC curve analysis showed that the AUC values of plasma Lp(a),ox-LDL,FIB and D-Dimer were 0.735,0.720,0.690 and 0.680 respectively,and the cut-off values were 335.50 mg/L,645.54 ng/ml,4.51 g/L and 378.58 ng/ml,respectively.Conclusion Plasma lipid metabolism and coagulation function indexes are closely related to the neurological deficit degree and prognosis in patients with massive cerebral infarction.The clinical examination can provide valuable evidence for treatment measures and prognosis evaluation.

关 键 词：大面积脑梗死 脂代谢 凝血功能 神经功能缺损程度 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]