血清胱抑素C、C-反应蛋白和同型半胱氨酸联合预测脑梗死患者短期预后的价值  

The value of cystatin C, C-reactive protein and homocysteine in predicting short-term prognosis of patients with acute cerebral infarction

作　　者：孙娜[1] 钟丽珍[1] 赵华[1] 程政平[1] Sun Na;Zhong Lizhen;Zhao Hua;Cheng Zhengping(Internal Medicine-Neurology,Liaoning Dalian Central Hospital,Dalian 116033,China)

机构地区：[1]辽宁省大连市中心医院神经内科,116033

出　　处：《心脑血管病防治》2021年第6期567-570,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的探讨血清胱抑素C(Cys-C)、C-反应蛋白(CRP)和同型半胱氨酸(Hcy)联合预测急性脑梗死(ACI)患者短期预后的价值。方法选取2014年7月至2020年7月大连市中心医院收治的的ACI患者444例,根据随访1个月时改良Rankin量表(mRS)评分分为预后良好组(mRS评分≤2分)255例和预后不良组(mRS评分>2分)189例。统计并比较两组患者基线资料,包括美国国立卫生研究院卒中量表(NIHSS)评分、Cys-C、CRP、Hcy等。采用受试者工作特征(ROC)曲线评估Cys-C、CRP、Hcy单一及联合检测对ACI患者短期预后的诊断效能,并采用多因素Logistic回归分析ACI患者短期预后的独立影响因素。结果预后不良组糖尿病史、贫血、皮层下白质病变所占比例显著高于预后良好组(χ^(2)=20.978、26.599、65.940,P <0.05);白细胞总数、NIHSS评分及血清Cys-C、CRP、Hcy水平显著高于预后良好组(t=11.096、14.309、116.159、28.756、8.162,P <0.05)。血清Cys-C、CRP、Hcy对ACI患者短期预后均有一定诊断效能,曲线下面积分别为0.674、0.808、0.721;而上述三项指标联合诊断ACI患者短期预后的曲线下面积为0.943。多因素Logistic回归分析显示,除糖尿病史、贫血、皮层下白质病、白细胞总数、NIHSS评分外,Cys-C、CRP、Hcy亦是ACI患者短期预后的独立影响因素[OR(95%CI)=1.048(1.010~1.087)、2.860(1.364~5.997)、2.550(1.040~6.252)、1.020(1.004~1.036)、1.645(1.384~1.955)、1.248(1.012~1.539)、2.378(1.956~2.891)、1.996(1.167~3.414),P <0.05]。结论Cys-C、CRP、Hcy对ACI患者短期预后均有一定诊断效能,而联合上述指标对患者短期预后的诊断效能更高。Objective To study the value of Cystatin C(Cys-C), C-reactive protein(CRP) and homocysteine(Hcy) in predicting the short-term prognosis of patients with acute cerebral infarction(ACI). Methods 444 patients with ACI in Liaoning Dalian Central Hospital from July 2014 to July 2020 were selected. According to the modified Rankin Scale(mRS) score at 1 month follow-up, theywere divided into good prognosis group(mRS score ≤ 2 points, 255 cases) and poor prognosis group(mRS score > 2 points, 189 cases). The baseline data of the two groups were analyzed and compared, including the National Institutes of Health Stroke Scale(NIHSS) score, Cys-C, CRP, Hcy, etc. The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficacy of single test and combined test of Cys-C, CRP and Hcy for short-term prognosis of ACI patients, and the independent influencing factors for short-term prognosis of ACI patients were analyzed by multivariate Logistic regression. Results The proportions of diabetes history, anemia, and subcortical white matter lesions in the poor prognosis group were significantly higher than those in the good prognosis group(χ^(2)=20.978, 26.599, 65.940;P < 0.05),and the total number of white blood cells, NIHSS score and serum Cys-C, CRP, and Hcy levels were significantly higher than those in the good prognosis group(t=11.096, 14.309, 116.159, 28.756, 8.162;P < 0.05). Serum Cys-C, CRP and Hcy had certain diagnostic efficacy for short-term prognosis of ACI patients, and the area under the curve was 0.674, 0.808 and 0.721, respectively. The area under the curve of the above three indicators in the diagnosis of short-term prognosis of ACI patients was 0.943.Multivariate Logistic regression analysis showed that in addition to diabetes history, anemia, subcortical white matter lesion, total white blood cell count and NIHSS score, Cys-C, CRP and Hcy were also independent influencing factors for short-term prognosis of ACI patients [OR(95%CI)=1.048(1.010-1.087), 2.860(1.364-5.997), 2.550(1.040-6.

关 键 词：胱抑素C C反应蛋白 同型半胱氨酸 急性脑梗死 

分 类 号：R743.3[医药卫生—神经病学与精神病学]