脑梗死患者不同时期血浆蛋白S水平与梗死范围的关系

Relation between plasma protein S level and infarction area in different period of cerebral infarction

目的:通过观察脑梗死患者外周血不同时期血浆蛋白S水平的变化,探讨蛋白S水平与脑梗死范围的关系。方法:选择2002-07/2003-01上海第二医科大学附属仁济医院神经内科住院或急诊留院观察急性脑梗死患者38例(脑梗死组)。对照组为来本院体检的健康者38例,性别、年龄均与脑梗死组相匹配(P>0.05)。脑梗死组在入院时(发病5d以内)、发病后20d采静脉血2mL(对照组与脑梗死组同时间点采血)。总蛋白S和游离蛋白S含量均采用双抗体夹心酶联免疫吸附法测定。结果:参加实验脑梗死组39例,对照组38例,均采样至实验结束。①不同病程阶段蛋白S水平的变化:脑梗死组急性期(5d内)、亚急性期(20d)总蛋白S水平均较对照组明显下降[(13.80±2.83),(14.69±2.66),(16.91±4.04)mg/L,(t=-3.888,-2.828,P<0.01)]。脑梗死组急性期、亚急性期游离蛋白S水平均较对照组明显下降[(6.36±2.02),(6.88±1.60),(8.80±2.41)mg/L,(t=-4.782,-4.095,P<0.01)]。②不同梗死范围蛋白S水平的变化:根据入院1周时MRI的检查结果分为腔隙性脑梗死组11例和非腔隙性脑梗死组27例。急性期、亚急性期非腔隙性脑梗死组患者总蛋白S水平低于腔隙性梗死组患者[急性期:(13.22±2.79),(15.22±2.50)mg/L;亚急性期:(13.88±2.16),(16.68±2.83)mg/L,(t=-2.062,-3.313,P<0.05)];明显低于对照组[(16.91±4.04)mg/L(t=-4.098,-3.906,P<0.01)]。急性期、亚急性期非腔隙性脑梗死组患者游离蛋白S水平低于腔隙性梗死组患者[(5.78±1.69),(7.79±2.14)mg/L;(6.41±1.40),(8.03±1.52)mg/L,(t=-3.077,-3.151,P<0.05)];明显低于对照组[(8.80±2.41)mg/L,(t=-5.944,-5.031,P<0.01)]。结论:脑梗死患者蛋白S水平在急性期、亚急性期均明显下降,其下降的水平与病灶大小有一定关系。

AIM： To discuss the association between plasma protein S level in peripheral blood and infarction area in different stages of cerebral infarction through observing the changes in the level of plasma protein S in peripheral blood. METHODS： Thirty-eight patients with acute cerebral infarction who were hospitalized or observed for disease in hospital were recruited from the Department of Neurology, Renji Hospital, Shanghai Second Medical University from July 2002 to January 2003. Other 38 health persons for health examination were selected as controls matched in terms of sex and age with the recruited patients. Venous blood of 2 mL was extract from the patients within 5 days and 20 days after onset and controls to determine the levels of total protein S and free protein S by using double-antibody sandwich-enzyme-linked immunoserbent assay.RESULTS： There was no loss in the participants during the experiment.① Changes of protein S levels in different stages of cerebral infarction： The levels of total protein S and free protein S in acute and subacute stages of cerebral infarction were decreased significantly as compared with the controls [（13.80±2.83）, （14.69±2.66）, （16.91±4.04）mg/L, （t=-3.888, -2.828, P 〈 0.01 ）; （6.36±2.02）, （6.88±1.60）, （8.80±2.41）mg/L, （t =-4.782 ,-4.095 ,P 〈 0.01 ）]. ② Infarction area and protein S level： According to the MRI results at admission, 38 patients were divided into lacunar infarction group （n=11） and non-lacunar infarction group （n=27）. The levels of total protein S and free protein S in the non-lacunar infarction group at acute and subacute stages were lower than those in lacunar infarction group [acute stage： （13.22±2.79）, （15.22±2.50）mg/L;subacute stage： （13.88±2.16）, （16.68±2.83） mg/L, （t=-2.062,-3.313,P 〈 0.05）; （5.78 ±1.69）, （7.79±2.14） mg/L; （6.41±1.40）,（8.03±1.52） mg/L, （t =-3.077, -3.151,P 〈 0.05）] and dramatically lower than those in the control group [（ 16.91 ±4.04） mg/L, （t=-4.098, -3.906,P 〈 0.01 ）; （8.80 ±2.41 ） rag/L, （t=-5.944,-5.031 ,P 〈 0.01 ）]. CONCLUSION： Protein S levels in acute and subacute stages of cerebral infarction are decreased significantly, and associated with infarct size to a certain extent.