脑梗死患者神经功能缺损与血浆载脂蛋白A1、B的水平

Relationship between neurologic impairment and levels of plasma apolipoprotein A1 and B in patients with cerebral infarction

目的:确定血浆载脂蛋白A1、载脂蛋白B、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平与脑梗死患者神经功能缺损的关系。方法:选择2004-06/2005-06在中南大学湘雅二医院神经内科住院的急性脑梗死患者238例,全部经头颅CT或MRI明确诊断,在患者入院第2天,空腹12h以上,清晨取肘静脉血2mL,检测血浆载脂蛋白A1、载脂蛋白B、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇浓度,并同时检测患者肝肾功能。根据梗死灶直径大小分为大梗死灶(直径≥40mm),中梗死灶(直径20～39mm),小梗死灶(直径<20mm)。将全部患者的血浆载脂蛋白A1、载脂蛋白B、低密度脂蛋白胆固醇及高密度脂蛋白胆固醇浓度由低到高进行排序,分别取各项指标前10个百分点与后10个百分点的患者进行神经功能缺损评分,并比较组间神经功能缺损评分及梗死灶大小的差异。患者神经功能缺损评分采用改良的爱丁堡与斯堪的纳维亚评分标准,包括意识、水平凝视功能、面瘫、言语、上肢肌力、手肌力、下肢肌力、步行能力8个方面。结果:238例患者均采集到血样,全部进入结果分析。①载脂蛋白A1:平均值(1.26±0.22)mmol/L,位于载脂蛋白A1前10百分位点共26例,神经功能缺损评分为10.51±1.61,位于后10百分点组共23例,神经功能缺损评分为7.29±1.03。两组间神经功能缺损评分差异具有显著性(P<0.01)。两组间梗死灶大小分布差异亦有显著性(P<0.01)。②载脂蛋白B平均值(0.87±0.23)mmol/L,位于前10百分点共24例,神经功能缺损评分为9.67±2.14,位于后10百分点共21例,神经功能缺损评分为11.63±2.39,两组间神经功能缺损评分差异没有显著性(P>0.05)。③高密度脂蛋白胆固醇平均值(1.17±0.31)mmol/L,位于前10百分点共22例,神经功能缺损评分为10.13±1.92,位于后10百分点共23例,神经功能缺损评分为9.23±1.91,两组间神经功能缺损评分差异无统计学意义(P>0.05)。④低密度脂蛋白胆固醇:平均值(2.89±0.98)mmol/L,位于前10百分点共23例,神经功能缺损评分10.00±2.22,位于后10百分点共23例,神经功能缺损评分为11.96±2.09,两组间神经功能缺损评分差异无明显统计学意义(P>0.05)。结论:载脂蛋白A1浓度相对较高的患者较浓度相对较低的患者神经功能缺损评分低,提示载脂蛋白A1水平与神经功能缺损评分相关,而载脂蛋白B、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇浓度与神经功能缺损评分无明显相关性。

AIM： To evaluate the relationship between levels of plasma apolipoprotein （APO） A1, Apo B, high-density lipoprotein cholesterol （HDL-C）, low-density lipoprotein cholesterol （LDL-C） and neurologic impairment in patients with cerebral infarction. METHODS： Totally 238 acute cerebral infarction patients, who were diagnosed at the Department of Neurology, Second Xiangya Hospital, Central South University by CT or MRI between June 2004 and June 2005, were enrolled. At the 2^nd day after hospitalizing and fasting for over 12 hours, 2 mL venous blood from elbow was gained in the morning so as to detect the concentration of plasma APO A1, APO B, HDL-C and LDL-C and the liver fun ction and renal function were measured at the same time. According to the size of infarcted focus it was assigned into big infracted focus （diameter t〉 40 mm）, moderate infarcted focus （diameter from 20-39 mm） and small infarcted focus （diameter 〈 20 mm）. From low to high the concentrations of plasma APO A1, APO B, LDL-C and HDL-C were arranged in order. Difference of score of neurologic impairment and size of infarcted focus was compared in the degree of neurologic impairment between the groups that the levels located the first 10 percentages and the last 10 percen/ages. The scale of neurologic impairment was evaluated according to Modified Edinburgh-Scandinavia Stroke Scale （MESSS）, which composed of consciousness, horizontal staring function, facial paralysis, language, muscle strength of upper limb, muscle strength of hand, muscle strength of lower limb and ability of walking. RESULTS： All 238 patients were got their samples of venous blood and involved in the result analysis. ①Apo A1： The average value was （1.26±0.22） retool/L, and there were 26 patients that the levels of serum Apo A1 located the first 10 percentage, and the average value of neurologie impairment was （10.51±1.61）, and there were 23 patients that the levels of serum ApoA1 loeated the last 10 percentage, the average value of neurologie impairment was （7.29±1,03）. There was a significant difference in the neurologie impairment between the two groups （P〈 0.01 ）. Distribution of infarcted focus in the two groups had signifieant differenee （P〈 0.01 ）. ②ApoB：the average value was （0.87±0.23） mmol/L, and there were 24 patients that the levels of serum ApoB located the first 10 percentage. The average value of neurologic impairment was （9.67±2.14）, and there were 21 patients that the levels of serum APOB located the last 10 percentage. The average value of neurologic impairment was （11.63 ±2.39）. There was no a significant difference in the neurologic impairment between the two groups （P 〉 0.05）. ③HDL-C： The average value was （1.17±0.31） mmol/L, and there were 22 patients that the levels of serum HDL-C located the first 10 percentage. The average value Of neurologic impairment was （10.13±1.92） and there were 23 patients that the levels ofserum HDL-C located the last 10 percentage. The average value of neurologic impairment was （9.23±1.91）. There was no a statistical difference in the neurologic impairment between the two groups （P 〉 0.05）, ④LDL-C： The average value was （2,89±0.98） mmol/L, there were 23 patients that the levels of serum LDL-C located the first 10 percentage. The average value of neurologic impairment was （10.00±2.22） and there were 23 patients that the levels of serum LDL-C located the last 10 percentage., and the average value of neurologic impairment was （11.96±9.09）. There was no a statistical difference in the neurologic impairment between the two groups （P 〉 0,05）. CONCLUSION： Score of neurologie impairment in patients with relatively high concentration of ApoA1 is lower as compared with the patients with relatively low concentration. It is indicated that the level of ApoA1 is related with the score of neurologic impairment, while the concentrations of ApoB, HDL-C and LDL-C have insignificant correlation with the neurolagic impairment,