补体系统激活变化趋势与急性脑梗死关系的临床研究

Clinical study on relationship between the activation of complement system and cerebral infarction

目的动态观察脑梗死患者发病后1月内补体C3和超敏C-反应蛋白(Hs-CRP)含量的变化趋势及其与梗死灶体积、神经功能缺损程度的相关性。方法分别在发病后12、24、48、72h、7、14d和1月,采用免疫散射比浊法测定56例脑梗死患者补体C3和Hs-CRP含量,观察并记录所有病例的病灶体积、神经功能缺损评分。同时选取46例健康受试者作为对照组。结果(1)病例组补体C3和Hs-CRP在不同测定时点浓度不同(F=163.456和97.622,P<0.001),表现为发病12h时补体C3和Hs-CRP浓度即有所增加,此后随着发病时间的增加浓度呈上升趋势,至发病7d达峰值,随后逐渐下降,至1月时趋于正常。(2)病例组血清C3、Hs-CRP的浓度于发病后12、24、48、72h、7、14d均高于对照组(P<0.05),1月时2组比较无明显差异(P>0.05);(3)病例组血清补体C3、Hs-CRP水平与梗死灶体积有关系,体积越大,血清补体C3、Hs-CRP水平越高。大、中病灶组血清补体C3、Hs-CRP浓度明显高于小病灶组(P<0.05);(4)病例组血清补体C3、Hs-CRP水平与神经功能缺损程度有关系,神经功能缺损越重,血清补体C3、Hs-CRP水平越高。重、中度神经功能缺损组血清补体C3、Hs-CRP浓度明显高于轻度缺损组(P<0.05)。结论(1)急性缺血性脑卒中患者在急性期C3、Hs-CRP含量增高,存在补体系统激活。补体激活可能参与了急性缺血性脑卒中后脑组织的炎症过程;(2)急性缺血性脑卒中患者C3、Hs-CRP与脑梗死体积、神经功能缺损程度之间有密切关系,反映卒中时脑组织的损害程度。

Objective To study dynamically the relativity of the change of serum complement 3 （123）, high-sensitivity C-reactive protein （Hs-CRP）, infarct volume and neurological impairment within one month after the patients suffering from acute cerebral infarction. Methods The content of Serum C3 and Hs-CRP level of 56 cerebral infarction patients and 46 Healthy Volunteers as comparation was detected by Nephelometry after the 12 h, 24 h, 48 h, 72 h, 7 d, 14 d and 30 d. To observe and record the score of case about infarct vol ume and neurological impairment. Results The levels of serum C3 and Hs-CRP in patients with cerebral infarction were higher significantly than that in the normal Controls after the 12 h, 24 h, 48 h, 72 h, 7 d and 14 d （P〈0. 05）, hut it had no significant differences between the two groups after 30 days （P〉0. 05）. The levels of serum C3 and Hs-CRP in patients with cerebral infarction were correlated with infarct volume, the bigger the infarct volume, the higher the levels of serum C3 and Hs-CRP. The levels of serum C3 and Hs-CRP in the large-focus group and middle-foeus group with cerebral infarction were higher significantly than that in the small-focus group with cerebral infarction （P〈0. 05）. The levels of serum C3 and Hs-CRP in patients with cerebral infarction were correlated with neurological impairment, the more serious the neurological impairment, the higher the levels of serum C4 and Hs-CRP. The leves of serum C4 and Hs CRP in the severe group and the moderate group with neurological impairment were higher significantly than that in the mild group with neurological impairment （P〈0. 05）. Conclusions The levels of serum C4 and Hs CRP in patients play a very important role in the occurrence and development of cerebral infarction. The increased levels of them have certain correlation with infarct volume and the degree of neurological impairment.