急性脑梗死超早期血浆TM、TAFI、IL-6、TNF-α水平与梗死体积的关系及诊断价值  

The Relationship and Diagnostic Value of Plasma TM,TAFI,IL-6 and TNF-αLevels with Infarct Volume in the Ultra-early Stage of Acute Cerebral Infarction

作　　者：吴彬 范秀博 董贞 王举波[4] 杨静[1] WU Bin;FAN Xiu-bo;DONG Zhen;WANG Ju-bo;YANG Jing(Department II of Neurology,The Second Affiliated Hospital of Xi'an Medical University,Xi'an,Shaanxi,710038,China;Department Ⅰ of Neurology,The Second Affiliated Hospital of Xi'an Medical University,Xi'an,Shaanxi,710038,China;Department of Emergency,The Second Affiliated Hospital of Xi'an Medical University,Xi'an,Shaanxi,710038,China;Neurosurgery Department,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanxi,710004,China)

机构地区：[1]西安医学院第二附属医院神经内二科,陕西西安710038 [2]西安医学院第二附属医院神经内一科,陕西西安710038 [3]西安医学院第二附属医院急诊科,陕西西安710038 [4]西安交通大学第二附属医院神经外科,陕西西安710004

出　　处：《现代生物医学进展》2024年第8期1500-1504,共5页Progress in Modern Biomedicine

基　　金：陕西省重点研发计划一般项目-社会发展领域(2020SF-257)。

摘　　要：目的:探讨急性脑梗死超早期血浆血栓调节蛋白(TM)、凝血酶激活纤溶抑制物(TAFI)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平与患者梗死体积的关系及对梗死体积的诊断价值。方法:将2018年6月-2019年9月期间于西安医学院第二附属医院就诊的75例急性脑梗死超早期患者纳入观察组,并把75例同期陈旧性脑梗死患者纳入对照组。检测观察组治疗前(且发病6 h内)、治疗3 d后及治疗7 d后以及对照组入院时血浆TM、TAFI、IL-6及TNF-α水平。比较观察组与对照组治疗前上述指标的差异。将观察组按照梗死体积分为小体积梗死组(27例)、中体积梗死组(30例)及大体积梗死组(18例),比较治疗前、治疗3 d及治疗7 d后三组上述指标的变化趋势及组间差异。采用有序Logistics回归分析治疗前上述指标与脑梗死体积的相关性;进行ROC分析治疗前上述指标对大体积梗死的诊断价值。结果:观察组治疗前(且发病6 h内)血浆TM、TAFI、IL-6及TNF-α水平均高于对照组(P<0.05)。随着病程的进展,治疗3 d后小体积梗死组、中体积梗死组及大体积梗死组上述指标均较治疗前降低(P<0.05),治疗7 d后则较治疗3 d后进一步降低(P<0.05);但各时间段大体积梗死组上述指标均高于中体积梗死组(P<0.05),而中体积梗死组的上述指标也均高于小体积梗死组(P<0.05)。有序Logistics回归分析提示治疗前上述指标水平对脑梗死体积可产生显著的正向影响。由ROC分析可见,治疗前上述指标均可用于诊断大体积梗死,且联合检测的诊断价值更优。结论:急性脑梗死患者血浆TM、TAFI、IL-6及TNF-α水平升高,但随病程的延长而下降,在急性脑梗死的发展中具有重要意义;在急性脑梗死超早期,患者的上述指标可能用于辅助诊断梗死体积。Objective:To explore the relationship between plasma thrombomodulin(TM),thrombin activated fibrinolytic inhibitor(TAFI),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)levels and infarct volume in patients with acute cerebral infarction in ultra-early stage and their diagnostic value for infarct volume.Method(s):75 patients with ultra-early acute cerebral infarction admitted to the Second Affiliated Hospital of Xi'an Medical University from Jun 2018 to Sep 2019 were included in the observation group,and 75 patients with outmoded cerebral infarction admitted in the same period were included in the control group.The plasma TM,TAFI,IL-6 and TNF-αlevels of patients before treatment(and within 6 hours of onset),3 days after treatment and 7 days after treatment in the observation group,and those of patients at admission in the control group were detected.The difference of the above indexes before treatment between the observation group and the control group was compared.The patients in the observation group were divided into small volume infarction group(n=27),medium volume infarction group(n=30)and large volume infarction group(n=18)according to infarction volume.The change trend and difference of the levels of the above indexes before treatment,3 days after treatment and 7 days after treatment among the three groups were compared.The correlation between the above indexes before treatment and the volume of infarction was analyzed by ordinal Logistic regression;The diagnostic value of the above indexes before treatment for large volume infarction was analyzed by ROC.Result(s):The plasma levels of TM,TAFI,IL-6 and TNF-αof patients before treatment(and within 6 hours of onset)in the observation group were higher than those of patients in the control group(P<0.05).With the progression of the disease course,the levels of the above indexes in patients with small volume infarction,medium volume infarction and large volume infarction decreased after 3 days of treatment compared to pre-treatment levels(P<0.05),and aft

关 键 词：急性脑梗死超早期 血栓调节蛋白 凝血酶激活纤溶抑制物 白细胞介素-6 肿瘤坏死因子α 

分 类 号：R743.32[医药卫生—神经病学与精神病学]