血清神经元特异性烯醇化酶同型半胱氨酸联合检测对急性脑梗死合并冠状动脉粥样硬化性心脏病患者的诊断及病情严重程度判断的临床意义

Clinical value of combined detection of serum neuron-specific enolase and homocysteine in the diagnosis and severity evaluation of acute cerebral infarction complicated with coronary heart disease

目的探究血清神经元特异性烯醇化酶(NSE)与血清同型半胱氨酸(Hcy)联合检测对急性脑梗死合并冠状动脉粥样硬化性心脏病(简称心脏病)患者的诊断及病情严重程度的判断价值。方法选择河南省襄城县人民医院2019年5月至2021年3月收治的急性脑梗死患者149例作为研究对象,根据是否合并冠心病分为单独组83例和合并组66例。另纳入同期来院体检健康者50名作为对照组。合并组患者根据疾病严重程度分为A组(小面积脑梗死、单支病变18例)、B组(小面积脑梗死、多支病变17例)、C组(大面积脑梗死、多支病变31例)。采用酶联免疫吸附试验检测所有受试者血清NSE、Hcy水平,比较各组受试者、不同严重程度合并症患者血清NSE、Hcy水平,采用ROC曲线分析血清NSE、Hcy单独及联合检测对合并组的诊断价值。结果对照组、单独组、合并组受试者血清NSE、Hcy水平依次递增(P<0.05);血清NSE、Hcy单独及联合检测对合并症患者诊断的特异度依次递减,敏感度依次递增,曲线下面积(AUC)依次递增;A、B、C 3组合并症患者血清NSE、Hcy水平依次递增(P<0.05);合并症患者血清NSE、Hcy水平与疾病严重程度均呈明显正相关(r=0.714,0.843,P<0.05)。结论血清NSE、Hcy联合检测对急性脑梗死合并冠心病具有较高的诊断效能;血清NSE、Hcy水平对急性脑梗死合并冠心病严重程度判断具有参考意义。

Objective To investigate the value of combined detection of serum neuron-specific enolase(NSE)and serum homocysteine(Hcy)in the diagnosis and severity evaluation of patients with acute cerebral in-farction complicated with coronary heart disease.Methods Retrospectively included in this study were 149 patients with acute cerebral infarction admitted to Xiangcheng County People′s Hospital between May 2019 and March 2021.According to presence of coronary heart disease,the patients were divided into the simple group(83 patients)and complicated group(66 patients).In addition,50 healthy subjects who visited our hospital for physical checkup during the same period were included as the control group.The patients in the complicated group were further di-vided into group A(18 patiact,with small-area cerebral infarction,single-vessel disease),group B(17 patients with small-area cerebral infarction,multi-vessel disease),and group C(31 patients with large-area cerebral in-farction,multi-vessel disease)according to severity of the disease.Enzyme-linked immunosorbent assay was used to measure the serum NSE and Hcy levels in all subjects.The serum NSE and Hcy levels were com-pared among subjects in each group and among patients with complications of different severity.ROC curve was used to analyze the diagnostic value of serum NSE and Hcy alone or in combination in patients of the complicated group.Results The serum NSE and Hcy levels in subjects increased from control group,simple group,to com-plicated group(P<0.05).In diagnosing the complicated cases,the specificity decreased,the sensitivity increased,and the AUC in-creased from detection of serum NSE alone,Hcy alone to combined NSE and Hcy detection.The serum NSE and Hcy levels increased from complicated cases in group A,B,to group C(P<0.05).The serum NSE and Hcy levels in complicated cases showed a significantly positive correlation with the disease severity(P<0.05).Conclusion Combined detection of serum NSE and Hcy offers high diagnostic efficiency for acute cerebral infarction compli-cated with coronary heart disease.Therefore,serum NSE and Hcy levels have referential implications for severity evaluation of acute cerebral infarction complicated with coronary heart disease.