后循环脑梗死患者椎基底动脉狭窄与血清生化指标及预后的关系  

Relationship between vertebrobasilar artery stenosis and serum biochemical indexes in patients with posterior circulation cerebral infarction

作　　者：刘文涛[1] 吴锋 席建平[1] 杨宝军[1] 马新 王谦 LIU Wentao;WU Feng;XI Jianping;YANG Baojun;MA Xin;WANG Qian(CT Room,Baoji Hospital of Traditional Chinese Medicine,Baoji,Shaanxi 721000,China;Department of Radiology,Baoji Hospital of Traditional Chinese Medicine,Baoji,Shaanxi 721000,China)

机构地区：[1]陕西省宝鸡市中医医院CT室,陕西宝鸡721000 [2]陕西省宝鸡市中医医院放射科,陕西宝鸡721000

出　　处：《检验医学与临床》2022年第3期316-320,共5页Laboratory Medicine and Clinic

摘　　要：目的探讨CT血管造影(CTA)评估后循环脑梗死(PCCI)患者椎基底动脉狭窄的价值及其与血清生化指标的关系。方法回顾性分析2017年5月至2019年5月该院收治的142例椎基底动脉狭窄患者的临床资料,均根据MRI检查结果确诊为短暂性脑缺血发作(TIA)、PCCI,分析患者血管病变情况与梗死部位,比较TIA、PCCI斑块性质,以及不同斑块性质PCCI患者神经功能损伤标志物[神经元特异性烯醇化酶(NSE)、S100B蛋白(S100B)、泛素C末端水解酶L1(UCH-L1)、胶质纤维酸性蛋白(GFAP)]、炎性反应指标[细胞间黏附分子-1(ICAM-1)、血管细胞黏附分子-1(VCAM-1)、血小板内皮细胞黏附分子-1(PECAM-1)、血管内皮钙黏蛋白(VE-cadherin)、几丁质酶-3样蛋白1(YKL-40)]、斑块性质相关蛋白酶[半胱氨酸组织蛋白酶S(CatS)、基质金属蛋白酶9(MMP9)、基质金属蛋白酶10(MMP10)、血小板反应蛋白解整合素金属肽酶12(ADAMTS12)]水平的差异,分析不稳定斑块性质与上述血清生化指标的相关性,并观察预后情况。结果不稳定斑块组患者PCCI构成比高于稳定斑块组和无斑块组,且PCCI患者斑块检出率明显高于TIA(P<0.05);椎动脉颅外段血管病变以远段梗死为主,椎动脉颅内段血管病变以近段梗死为主,基底动脉血管病变以中段梗死为主,大脑后动脉血管病变以远段梗死为主;不稳定斑块组患者血清生化指标NSE、S100B、UCH-L1、GFAP、ICAM-1、VCAM-1、PECAM-1、VE-cadherin、YKL-40、CatS、MMP9、MMP10、ADAMTS12水平均高于稳定斑块组和无斑块组(P<0.05);Pearson相关性显示,不同斑块性质与血清生化指标水平均呈正相关(P<0.001),不稳定斑块PCCI患者复发率高于稳定斑块组和无斑块组(P<0.05)。结论PCCI患者椎基底动脉狭窄的CTA评估价值较高,动脉粥样斑块性质稳定性与神经损伤程度、炎性反应及斑块性质相关蛋白酶分子异常激活密切相关,且斑块性质不稳定患者复发风险高。Objective To investigate the value of CT angiography(CTA)in evaluating vertebrobasilar artery stenosis in patients with posterior circulation cerebral infarction(PCCI)and its relationship with serum biochemical indicators.Methods A retrospective analysis of the clinical data of 142 patients with vertebrobasilar artery stenosis admitted to the hospital from May 2017 to May 2019.All were diagnosed as TIA and PCCI based on the results of MRI examinations.The patient′s vascular lesions and infarct locations were analyzed,and the difference in plaque properities between TIA and PCCI were compared.Neurological damage markers[neuron-specific enolase(NSE),S100B protein(S100B),ubiquitin C-terminal hydrolase L1(UCH-L1),glial fibrillary acidic protein(GFAP)],inflammatory response indicators[intercellular adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1),platelet endothelial cell adhesion molecule-1(PECAM-1),vascular endothelial cadherin(VE-cadherin),chitinase-3 like protein 1(YKL-40)],protease related to plaque properties[cysteine cathepsin S(CatS),matrix metalloproteinase 9(MMP9),matrix metalloproteinase 10(MMP10),a disintegrin and metalopeptidase with thrombospondin motif 12(ADAMTS12)]of PCCI patients with different plaque properties were compared.The correlation between unstable plaque properties and the above serum biochemical indicators was analyzed,and the prognosis was observed.Results The proportion of PCCI in the unstable plaque group was higher than that in the stable plaque group and the non-plaque group,and the detection rate of plaque in PCCI patients was significantly higher than that of TIA(P<0.05).The lesions of extracranial vertebral artery were mainly distal infarction,intracranial vertebral artery vascular disease was mainly proximal infarction,basilar artery vascular disease was mainly middle infarction,and posterior cerebral artery vascular disease was mainly distal infarction.Serum biochemical indexes of patients in unstable plaque group were NSE,S100B,UCH-L1,GFAP,ICAM-1,VCAM-1,PE

关 键 词：椎基底动脉狭窄 后循环脑梗死 CT血管造影 血清生化指标 预后 相关性 

分 类 号：R446.1[医药卫生—诊断学] R743.3[医药卫生—临床医学]