DWI联合BNP、CysC及LDH检测在急性脑梗死预后判断中的作用  

The role of DWI combined with detection of BNP,CysC and LDH in judging the prognosis of acute cerebral infarction

作　　者：郭咏娣 武剑 宋晓微 GUO Yongdi;WU Jian;SONG Xiaowei(Department of Neurology,the 731 Hospital of China Aerospace Science and Industry Group,Beijing,China,100074;Department of Neurology,Tsinghua Changgeng Hospital,Beijing,China,100084)

机构地区：[1]中国航天科工集团七三一医院神经内科,北京100074 [2]北京清华长庚医院神经内科,北京100084

出　　处：《分子诊断与治疗杂志》2023年第7期1164-1168,共5页Journal of Molecular Diagnostics and Therapy

基　　金：首都卫生发展科研专项资助(2018⁃1⁃223135)。

摘　　要：目的探讨磁共振弥散成像(DWI)联合B型尿钠肽(BNP)、胱抑素C(CysC)及乳酸脱氢酶(LDH)检测在急性脑梗死(ACI)预后判断中的作用。方法选取2018年12月至2020年12月中国航天科工集团七三一医院收治的174例ACI患者(研究组),另将本院同期健康体检者87名为对照组,根据ACI患者出院3个月后复查随访时改良Rakm量表(mRS)评分情况分为预后良好、预后中等及预后较差,比较不同人群及ACI不同预后患者美国国立卫生研究院卒中量表(NIHSS)评分、简式Fugl⁃Meyer运动功能评分(Fugl⁃Meyer评分)、DWI相关参数[各向异性系数(FA)和表观扩散系数(ADC)]及血清BNP、CysC及LDH水平;采用直线Pearson分析FA、ADC、BNP、CysC及LDH与NIHSS、Fugl⁃Meye、mRS评分的相关性,分析DWI联合BNP、CysC及LDH对急性脑梗死预后的预测价值。结果ACI组DWI检查中参数FA、ADC值均显著低于对照组,而血清BNP、CysC及LDH水平均显著高于对照组,差异均有统计学意义(P<0.05);根据随访结果可知,174例ACI患者中预后良好55例,预后中等78例,预后较差41例;治疗后,三组NIHSS评分、BNP、CysC及LDH水平比较:预后良好组<预后中等组<预后较差组;Fugl⁃Meyer评分及FA、ADC值比较:预后良好组>预后中等组>预后较差组,差异均有统计学意义(P<0.05);Pearson直线分析显示:FA、ADC与NIHSS、mRS呈负相关,与Fugl⁃Meye呈正相关;BNP、CysC及LDH与NIHSS、mRS呈正相关,与Fugl⁃Meye呈负相关(P<0.05);DWI联合BNP+CysC+LDH检测对ACI患者预后的预测价值明显优于DWI、BNP、CysC及LDH单项检测(P<0.05)。结论DWI参数及BNP、CysC、LDH在ACI患者中均呈异常表达,且FA、ADC、BNP、CysC及LDH与NIHSS、Fugl⁃Meye、mRS评分具有明显相关性,DWI联合BNP、CysC、LDH检测在预测ACI患者预后中具有显著作用。Objective To explore the effects of magnetic resonance diffusion weighted imaging(DWI)combined with B⁃type natriuretic peptide(BNP),cystatin C(CysC)and lactate dehydrogenase(LDH)detection in the judging prognosis of acute cerebral infarction(ACI).Methods 174 ACI patients admitted to the 731 Hospital of China Aerospace Science and Industry Corporation from December 2018 to December 2020 were selected(study group),another 87 cases who underwent physical examination in our hospital during the same period were selected as the control group,according to the modified Rakm scale(mRS)scores of patients with ACI at follow⁃up 3 months after discharge,they were divided into good prognosis,intermediate prognosis and poor prognosis,The National Institute of Health stroke scale(NIHSS)score,short Fugl⁃Meyer motor function score(Fugl⁃Meyer score),DWI related parameters[Fractional anisotropy(FA),Average diffusion coefficient(ADC)]and serum BNP,CysC and LDH levels in different groups of people and patients with different prognosis of ACI were compared;the correlation between FA,ADC,BNP,CysC,and LDH and NIHSS,Fugl⁃Meye,and mRS scores was analyzed by linear Pearson,and the predictive value of DWI combined with BNP,CysC,and LDH on the prognosis of acute cerebral infarction was analyzed.Results The values of FA and ADC in the DWI examination of the ACI group were significantly lower than those of the control group,while the levels of serum BNP,CysC and LDH in the ACI group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).According to the follow⁃up results,among the 174 patients with ACI,55 had a good prognosis,78 had a moderate prognosis,and 41 had a poor prognosis.After treatment,the comparison of NIHSS score,BNP,CysC and LDH levels among the three groups:the good prognosis group<the medium prognosis group<the poor prognosis group;Fugl⁃Meyer score and FA,ADC value comparison:good prognosis group>medium prognosis group>poor prognosis group,the difference w

关 键 词：磁共振弥散成像 B型尿钠肽 胱抑素C 乳酸脱氢酶 急性脑梗死 

分 类 号：R743.33[医药卫生—神经病学与精神病学]