老年急性脑梗死患者血清脂蛋白a、生长分化因子15及D-二聚体水平变化及其诊断价值研究  

Changes of Serum Levels of Lp(a),GDF-15 and D-dimer and Their Diagnostic Value in Elderly Patients with Acute Cerebral Infarction

作　　者：张茜[1] 张波[1] 朱武[1] ZHANG Qian;ZHANG Bo;ZHU Wu(Ankang Hospital of Traditional Chinese Medicine,Ankang 725000,China)

机构地区：[1]陕西省安康市中医医院

出　　处：《实用心脑肺血管病杂志》2019年第8期56-61,67,共7页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：陕西省医学科学研究重点课题计划项目（2016JM3954）

摘　　要：背景血清脂蛋白a〔Lp(a)〕、生长分化因子15(GDF-15)及D-二聚体水平与脑血管疾病有关,但其对老年急性脑梗死(ACI)的诊断价值尚不明确。目的分析老年ACI患者血清Lp(a)、GDF-15及D-二聚体水平变化及其诊断价值。方法选取2016年10月—2018年10月安康市中医医院神经内科收治的老年ACI患者96例为研究组,同期门诊体检正常老年人80例为对照组。根据美国国立卫生研究院卒中量表(NIHSS)评分将研究组患者分为轻度神经功能缺损26例(NIHSS评分<6分)、中度神经功能缺损32例(6分≤NIHSS评分<13分)、重度神经功能缺损38例(NIHSS评分≥13分);根据入院后首次CT/磁共振成像(MRI)检查结果及Adama分型标准将研究组患者分为大面积梗死37例(病灶直径>3.00 cm并累及2个脑解剖部位)、小面积梗死33例(病灶直径为1.50~3.00 cm)、腔隙性梗死26例(病灶直径<1.50 cm)。比较两组受试者一般资料、实验室检查指标,不同神经功能缺损程度、梗死面积老年ACI患者血清Lp(a)、GDF-15、D-二聚体水平;血清Lp(a)、GDF-15、D-二聚体水平间的相关性分析采用Pearson相关分析;绘制ROC曲线以分析血清Lp(a)、GDF-15、D-二聚体水平及三者联合对老年ACI的诊断价值。结果(1)两组受试者年龄、性别、体质指数(BMI)、高脂血症发生率、ACI家族史、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)比较,差异无统计学差异(P>0.05);研究组患者高血压、糖尿病、冠心病发生率及血清Lp(a)、GDF-15、D-二聚体水平高于对照组(P<0.05)。(2)Pearson相关分析结果显示,血清Lp(a)水平与老年ACI患者血清GDF-15、D-二聚体水平呈正相关(r值分别为0.552、0.649,P<0.05),血清GDF-15水平与老年ACI患者血清D-二聚体水平呈正相关(r=0.543,P<0.05)。(3)中、重度神经功能缺损老年ACI患者血清Lp(a)、GDF-15、D-二聚体水平高于轻度神经功能缺损Background Serum levels of Lp(a),GDF-15,D-dimer are significantly related to cerebrovascular diseases,but their diagnostic value on acute cerebral infarction(ACI)in elderly patients remain to be explored.Objective To analyze the changes of serum levels of Lp(a),GDF-15 and D-dimer and their diagnostic value in elderly patients with ACI.Methods From October 2016 to October 2018,a total of 96 elderly patients with ACI were selected as study group in the Department of Neurology,Ankang Hospital of Traditional Chinese Medicine,meanwhile 80 normal elderly people underwent physical examination in the Outpatient Department were selected as control group.According to the NIHSS score,patients in the study group were classified as mild neurological impairment(NIHSS score<6,n=26),moderate neurological impairment(6≤NIHSS score<13,n=32)and severe neurological impairment(NIHSS score≥13,n=38);according to the first CT/MRI examination results and Adama classification standard,patients in study group were classified as massive infarction(diameter of nidus>3.00 cm and involved two brain anatomical sites,n=37),small infarction(diameter of between 1.50 and 3.00 cm,n=33)and lacunar infarction(diameter of nidus<1.50 cm,n=26).General information and laboratory examination results were compared between the two groups,serum levels of Lp(a),GDF-15 and D-dimer were compared in elderly ACI patients with different degrees of neurological impairment and infarction areas;correlations between each two of serum levels of Lp(a),GDF-15 and D-dimer were analyzed by Pearson correlation analysis;ROC curve was drawn to analyze the diagnostic value of serum levels Lp(a),GDF-15 and D-dimer and their combination in elderly patients with ACI.Results(1)There was no statistically significant difference in age,gender,BMI,incidence of hyperlipidemia,family history of ACI,TC,TG,HDL-C,LDL-C or UA between the two groups(P>0.05);incidence of hypertension,diabetes and coronary heart disease,serum levels of Lp(a),GDF-15 and D-dimer in study group were statistical

关 键 词：脑梗死 老年人 脂蛋白A 生长分化因子15 D-二聚体 诊断 灵敏度 特异度 

分 类 号：R743.33[医药卫生—神经病学与精神病学]