血管内皮细胞钙黏蛋白在急性脑梗死诊断中的应用

Application of serum VE-cadherin in patients with progressive cerebral infarction

目的探讨血管内皮细胞钙黏蛋白（VE-cadherin）在进展性脑梗死发病过程中的变化及临床意义。方法病例组：急性脑梗死患者167例，为2006年5月至2007年7月期间在山东省荣军总医院和滕州市中心人民医院的住院患者，符合1995年全国第四届脑血管病会议修订的诊断标准。其中进展性脑梗死102例，按Pullicino公式计算，分为大梗死灶组（32例），中梗死灶组（34例）和小梗死灶组（36例）。病情程度按1995全国第四届脑血管病会议通过的脑卒中患者临床神经功能缺损程度评分标准分为3组：轻型组38例，中型组32例，重型组32例。稳定性脑梗死组65例，病情稳定，无头痛、头晕及耳鸣等不适。对照组：共60名，来自健康体检者，排除各种急慢性疾病。所有急性脑梗死患者在入院当时采集肘静脉血（发病6h内），以后分别在24h,3d、7d、14d、21d分别采集清晨空腹静脉血，对照组采等量空腹静脉血，分离血清进行检测。VE-cadherin采用酶联免疫．双抗体夹心法测定。计量资料以均数±标准差（x±s）表示。应用SPSS10．0软件统计处理，多组间均数比较采用One-way ANOVA。结果进展性脑梗死患者血清VE-cadherin急性期升高，发病3d达高峰，以后逐渐下降，7d下降明显，21d接近正常对照，与稳定性脑梗死组和对照组相比，有非常显著意义（P〈0．01）。梗死体积大则血清VE-cadherin浓度高；重型组血清VE-cadherin浓度高于轻型组。结论血清VE-cadherin浓度与梗死大小、病程、病情严重程度相关，进展性脑梗死患者血清VE-cadherin高于稳定性脑梗死组和对照组。VE-cadherin可作为脑梗死的预警因子，对缺血性脑血管病的防治具有重要的临床应用价值。

Objeetive To investigate the changes and clinical implications of VE-cadherin during the course of progressive cerebral infarction. Method One hundred sixty-seven patients with acute cerebral infarction of Rong Jun General Hospital of Shandong Province and the Central People＇ s Hospital of Tengzhou were diagnosed in our hospital from May 2006 to July 2007, were diagnosed according to the diagnostic criteria set by the 4th national cerebrovascular disease conference in 1995. Of them there were 102 ases with progressive cerebral infarction patients and 65 cases with non-progressive cerebral infarction. The progressive cerebral infarction patients were divided into 3 groups according to Pullicino＇ s expressions： the big infarction focus（32 patients）, the medlum-sized infarction focus（34 patients） and the small infarction focus（36 patients）. The neurological deficits were divided into 3 groups according to the crrteria set by the 4th national cerebrovascular disease conference in 1995： light-deficits （38 patients） ,the moderate dificits （32 patients） and sever ditlcits （32 patients）.The 65 non-progressive infarction patients were stable without headache, vertigo and tinnitus. Arother 60 healthy subjects were entered as control group. Blood samples of all the patients＇ were collected at 0 h,24 h,3 d,7 d, 14 d,24 d and the serum VE-cadherin by ELISA method was assayed. All the data were analyzed by SPSS 10.0 software and One-way ANOVA was applied to intergroup comparisons for more than two groups, Results The VE-cadherin level of patients with progressive infarction increased in acute stage, reached the peak 3 days after onset, declined remarkably 7 days later and got nearly normalized within 21 days. The results were significantly different from those of non-progressive and control group （ P 〈 0. 01 ）. The VE-cadherin concentration was higher in patients with bigger size infarction and more sever symptoms. Conclusions The VE-cadherin level is related to the infarction size, course and the severity, and higher in the progressive group. VE-cadherin could be used for predicting prognostic of cerebral infarction and clinically valuable for treating isehemic cerebrovascular disease.