缺血性脑卒中患者血清GR,SOD,Cys-C,Hcy和Lp(a)水平对预后的预警价值研究  

Study on the Prognostic Warning Value of Serum GR,SOD,Cys-C,Hcy and Lp(a)Levels in Patients with Cerebral Ischemic Stroke

作　　者：李芳 冉向阳 李玮 史文俊 安黎云 康林[2] LI Fang;RAN Xiangyang;LI Wei;SHI Wenjun;AN Liyun;KANG Lin(Department of Clinical Laboratory,980 Hospital of Joint Logistic Support Force,Shijiazhuang 050000,China;Department of Clinical Laboratory,Hebei Provincial People’s Hospital,Shijiazhuang 050000,China)

机构地区：[1]联勤保障部队第九八〇医院检验科,石家庄050000 [2]河北省人民医院检验科,石家庄050000

出　　处：《现代检验医学杂志》2025年第2期92-97,103,共7页Journal of Modern Laboratory Medicine

基　　金：2021年度河北省医学科学研究课题计划:20210268。

摘　　要：目的探究缺血性脑卒中(CIS)患者血清谷胱甘肽还原酶(GR)、超氧化物歧化酶(SOD)、胱抑素C(Cys-C)、同型半胱氨酸(Hcy)和脂蛋白a[Lp(a)]水平对预后的预警价值,为改善缺血性脑卒中患者预后提供参考。方法选取2022年6月~2023年4月联勤保障部队第九八〇医院收治的126例CIS患者为观察组,另以1∶1比例选取同期健康体检者126例为对照组,分别于入院后、体检时检测比较两组血清GR,SOD,Cys-C,Hcy和Lp(a)表达水平,根据美国国立卫生院卒中量表(NIHSS)将CIS患者神经功能缺损程度划分为轻度(NIHSS:2~4分,n=35)、中度(NIHSS:5~15分,n=47)、中重度(NIHSS:16~20分,n=26)和重度(NIHSS:21~42分,n=18),比较不同神经功能缺损程度患者血清GR,SOD,Cys-C,Hcy和Lp(a)表达情况,分析各指标与神经功能缺损程度的相关性。观察组入院后均给予静脉溶栓治疗,于溶栓后1天再次检测,治疗后随访28天,根据患者病情转归情况(改良Rankin量表)分为预后良好组(n=94)和预后不良组(n=32),比较不同预后患者各指标水平,分析GR,SOD,Cys-C,Hcy和Lp(a)表达对预后不良的预测价值及早期预警。结果观察组血清GR(48.54±3.07U/L),SOD(157.17±25.47U/ml)表达水平低于对照组(61.68±3.15U/L,203.63±18.31U/ml);Cys-C(1.24±0.28mg/L),Hcy(15.21±1.62μmol/L),Lp(a)(386.53±52.16mg/L)表达水平高于对照组(0.82±0.23mg/L,9.58±0.60μmol/L,257.83±45.34mg/L),差异具有统计学意义(t=13.011~36.582,均P<0.05)。随病情的加重,GR,SOD表达水平逐渐降低,Cys-C,Hcy,Lp(a)表达水平逐渐增加,差异具有统计学意义(F=14.685~197.041,均P<0.05)。Spearman分析,GR,SOD与CIS患者神经功能缺损程度呈负相关(r=-0.814,-0.753,均P<0.05),Cys-C,Hcy,Lp(a)与CIS患者神经功能缺损程度呈正相关(r=0.647,0.782,0.724,均P<0.05)。预后良好组患者入院时、溶栓后1天的GR,SOD表达均高于预后不良患者(t=9.109,6.338;2.934,4.358,均P<0.05),Cys-C,Hcy和Lp(a)均低于预后不良患者(t=5.246,5.118,8.5Objective To explore the prognostic value of serum glutathione reductase(GR),superoxide dismutase(SOD),cystatin C(Cys-C),homocysteine(Hcy)and lipoprotein a[Lp(a)]levels in patients with cerebral ischemic stroke(CIS),and to provide a reference for improving the prognosis of CIS patients.Methods 126 patients with CIS admitted to the 980th Hospital of Joint Logistics Support Force from June 2022 to April 2023 were selected as the observation group,another 126 healthy individuals were selected as the control group at a ratio of 1:1.The expression levels of GR,SOD,Cys-C,Hcy and Lp(a)in the two groups were detected and compared after admission and during physical examination.The degree of neurological deficit in patients with CIS was classified into mild(NIHSS:2~4 points,n=35),moderate(NIHSS:5~15 points,n=47),moderate-severe(NIHSS:16~20 points,n=26)and severe(NIHSS:21~42 points,n=18)according to the National Institutes of Health Stroke Scale(NIHSS).The expression of serum GR,SOD,Cys-C,Hcy and Lp(a)in patients with different degrees of neurological deficit was compared,and the correlation between each indicator and the degree of neurological deficit was analyzed.The observation group received intravenous thrombolytic therapy after admission and was reexamined one day after thrombolysis.After treatment,follow-up visits were conducted for 28 days.According to the patient’s condition(modified Rankin scale),patients were divided into good prognosis(n=94)and poor prognosis groups(n=32).The levels of each indicator in patients with different prognoses were compared,and the predictive value of GR,SOD,Cys-C,Hcy and Lp(a)expression for poor prognosis and early warning were analyzed.Results The expression levels of serum GR(48.54±3.07U/L)and SOD(157.17±25.47U/ml)in the observation group were lower than those in the control group(61.68±3.15U/L,203.63±18.31U/ml),while the expression levels of Cys-C(1.24±0.28mg/L),Hcy(15.21±1.62μmol/L)and Lp(a)(386.53±52.16mg/L)were higher than those in the control group(0.82±0.23mg/L,9.5

关 键 词：缺血性脑卒中 谷胱甘肽还原酶 超氧化物歧化酶 胱抑素C 同型半胱氨酸 脂蛋白A 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R446.112[医药卫生—临床医学]