无症状脑梗死患者血清高敏C反应蛋白和肿瘤坏死因子-α水平的变化及其临床意义

Changes of Serum High-Sensitivity C-Reactive Protein and Tumor Necrosis Factor-α and Their Clinical Significance in Patients with Silent Cerebral Infarction

目的:探讨无症状脑梗死(SCI)患者血清高敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)水平的变化及其在发病机制中的作用。方法:分别检测40例SCI、40例脑梗死(CI)患者、40例健康对照者血清hs-CRP和TNF-α含量。结果:SCI组和CI组hs-CRP含量分别为(8.86±0.96)和(16.32±1.88)mg/L,均显著高于对照组的(1.69±0.56)mg/L(P<0.01),CI组hs-CRP含量亦显著高于SCI组(P<0.05);SCI组和CI组TNF-α含量分别为(1.92±0.73)和(2.56±0.91)ng/mL,显著高于对照组的(1.13±0.42)ng/mL(P<0.01),CI组TNF-α含量亦显著高于SCI组(P<0.05)。在SCI患者中,梗死灶数>2个组(n=19)hs-CRP为(9.45±0.97)mg/L,显著高于梗死灶数≤2个组(n=17)的(7.21±0.75)mg/L(P<0.01),两组TNF-α含量分别为(1.97±0.83)和(1.66±0.56)ng/mL,无显著差异。血压测定值越高,腔隙性梗死灶数量越多,未服降压药者梗死灶数量显著多于正规降压治疗者(P<0.05)。结论:炎症过程参与了脑小血管病变;hs-CRP和TNF-α水平与脑缺血程度、神经功能缺损程度以及脑的小血管病变范围密切相关。高血压是腔隙性SCI最常见的病因,未降压治疗的重度高血压更易引起多发性腔隙性脑梗死。从预防再发的角度看,对SCI应尽早采取积极有效的治疗措施,高血压患者应尽早正规服用降压药。

Objective： To investigate the changes of serum high-sensitivity C-reactive protein （hs-CRP） and tumor necrosis factor-α （TNF-α） levels in patients with silent cerebral infarction （SCI） and their roles in pathogenesis. Methods： The levels of serum hs-CRP and TNF-α in patients with SCI （n =40）, cerebral infarction （CI） （n =40） and healthy controls （n = 40） were measured respectively. Results： The levels of hs-CRP in both SCI and CI groups were 8.86 ± 0. 96 and 16.32±1.88 mg/L, respectively. They were significantly higher than 1.69 ±0. 56 mg/L in the control group （P 〈0.01）. The levels of hs-CRP in the CI group were also signifi- cantly higher than those in the SCI group （P 〈0.05）; the levels of TNF-α in both SCI and CI groups were 1.92 ±0.73 and2.56±0.91 ng/mL, respectively. They were significantly higher than 1. 13 ± 0.42 ng/mL in the control group （P 〈 0.01 ）. The levels Of TNF-α in the CI group were also significantly higher than those in the SCI group （P 〈 0.05）. The numbers of infarction 〉2 in the SCI group （n = 19）, hs-CRP was 9.45 ±0.97 rag/L, and it was significantly higher than 7.21±0.75 mg/L for the numbers of infarction ≤ 2 in the SCI group （n = 17） （P 〈 0.01 ）. 3]ae levels of TNF-α in both groups were 1.97±0. 83 and 1.66±0. 56 ng/mL, respectively,There was no significant difference, The higher the blood pressure values, the more the numbers of lacunar infarction would be. The numbers of infarction in patients who did not take antihypertensive drugs were significantly higher than those who took medicine regularly （P 〈 0.05）. Conclusions： Inflammatory process has involved in the small vascular lesion in brain; the levels of serum hs-CRP and TNF-α are closely correlated with the degree of cerebral ischemia, the degree of neurological deficit and the range of small vascular lesion in brain. Hypertension is the most comnon cause of lacunar SCI. Untreated severe hypertension is more likely to cause multiple lacunar infarction. From the point view of preventing recurrence, SCI should be treated with active and effective measures as soon as possible. Hypertensives should take antihypertensive drugs regularly as early as possible.