卵圆孔未闭导致隐源性卒中患者血清cTn I,NSE水平检测及诊断价值研究  

Detection and Diagnostic Value of Serum cTn I,NSE Levels in Patients with Cryptogenic Stroke with Patent Foramen Ovale

作　　者：赵海燕[1] 李源 王鹏[2] ZHAO Haiyan;LI Yuan;WANG Peng(Department of Neurology,Dazhou Central Hospital,Sichuan Dazhou 635000,China;Department of Cardiovascular Surgery,Dazhou Central Hospital,Sichuan Dazhou 635000,China)

机构地区：[1]达州市中心医院神经内科,四川达州635000 [2]达州市中心医院心脏血管外科,四川达州635000

出　　处：《现代检验医学杂志》2025年第1期158-162,168,共6页Journal of Modern Laboratory Medicine

基　　金：四川省卫生健康委员会医学科技项目(项目编号:21PJ198)。

摘　　要：目的 探究卵圆孔未闭(PFO)导致隐源性卒中患者血清心肌钙蛋白I(cTn I)、神经元特异性烯醇化酶(NSE)蛋白表达及诊断价值。方法 选取2020年12月~2022年12月达州市中心医院收治的PFO患者108例,根据患者是否导致隐源性卒中分为隐源性卒中组(卒中组,n=32)和非隐源性卒中组(未卒中组,n=76)。根据美国国立卫生研究院卒中量表(NIHSS)评估神经功能缺损程度,分为轻度组(<4分,n=10)、中度组(4~15分,n=15)和重度组(>15分,n=7)。全自动生化分析仪检测所有患者纤维蛋白原(FIB)、C反应蛋白(CRP)和丙氨酸氨基转移酶(ALT)水平。采用ELISA检测血清中cTn I,NSE水平。ROC曲线分析血清cTn I,NSE对PFO导致隐源性卒中的诊断价值;Logistic回归分析影响PFO患者隐源性卒中发生的因素。结果 与未卒中组相比,卒中组患者FIB(3.20±0.36g/L vs 2.95±0.30g/L),CRP(73.58±7.43mg/L vs 62.52±7.11mg/L),ALT(68.58±6.82U/L vs 61.08±6.28U/L),cTn I(0.78±0.10ng/L vs 0.58±0.08ng/L)和NSE(37.52±3.82μg/L vs 30.35±3072μg/L)水平显著升高,差异具有统计学意义(t=3.722~10.994,均P <0.05)。与轻度组相比,中度组和重度组患者血清中cTn I,NSE水平显著升高(t=5.891,7.177;3.458,4.105),重度组cTn I,NSE水平显著高于中度组(t=2.474,1.336),差异具有统计学意义(均P<0.05)。二者联合诊断PFO患者隐源性卒中发生的AUC(95%CI)为[0.981(0.962~1.000)],高于cTn I[0.878(0.864~0.948)],NSE[0.911(0.850-0.972)]单独诊断(Z=8.621,6.477,均P <0.001)。Logistic回归分析显示,cTn I(OR=2.631,95%CI:1.508~4.591),NSE(OR=2.841,95%CI:1.514~5.330)是PFO患者隐源性卒中发生的影响因素(均P <0.05)。结论 PFO患者导致隐源性卒中患者血清中cTn I,NSEl水平显著升高,对PFO患者发生隐源性卒中具有一定的诊断价值。Objective To explore the expression and diagnostic value of serum cardiac troponinⅠ(cTnⅠ)and neuronspecific enolase protein(NSE)in patients with cryptogenic stroke caused by patent foramen ovale(PFO).Methods A total of 108 patients with PFO admitted to Dazhou Central Hospital from December 2020 to December 2022 were selected and divided into 32 patients with cryptogenic stroke group(stroke group)and 76 patients with non-cryptogenic stroke group(non-stroke group)according to whether the patients caused cryptogenic stroke.According to the National Institutes of Health Stroke Scale(NIHSS),they were divided into mild group(<4points,n=10),moderate group(4~15points,n=15)and severe group(>15points,n=7).levels of fibrinogen(FIB),C-reactive protein(CRP),and alanine aminotransferase(ALT)were measured by an automatic biochemical analyzer in all patients.The serum levels of cTn I and NSE were detected by ELISA-diagnostic value of serum cTn I and NSE in PFO-induced cryptogenic stroke by ROC curve analysis.Logistic regression was applied to analyze the factors affecting the occurrence of cryptogenic stroke in PFO patients.Results Compared with the non-stroke group,the levels of FIB(3.20±0.36g/L vs 2.95±0.30g/L),CRP(73.58±7.43mg/L vs 62.52±7.11mg/L),ALT(68.58±6.82U/L vs 61.08±6.28U/L),cTn I(0.78±0.10ng/L vs 0.58±0.08ng/L)and NSE(37.52±3.82μg/L vs 30.35±3.72μg/L)in the stroke group were increased,and the differences were statistically significant(t=3.722~10.994,all P<0.05).Compared with the mild group,the levels of cTn I and NSE in the serum of patients in the moderate and severe groups were increased(t=5.891,7.177;3.458,4.105),the levels of cTn I,NSE in the serum of the severe group were significantly higher than those in the moderate group(t=2.474,1.336),the differences were statistically significant(all P<0.05).The AUC(95%CI)for the combined diagnosis of cryptogenic stroke in PFO patients was[0.981(0.962~1.000)],which was higher than cTn I[0.878(0.864~0.948)],NSE[0.911(0.850~0.972)]diagnosed alone(Z=8.621,6.47

关 键 词：心肌钙蛋白I 神经元特异性烯醇化酶蛋白 卵圆孔未闭 隐源性卒中 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R446.11[医药卫生—临床医学]