不同病因学亚型急性脑梗死患者超敏C-反应蛋白的动态变化及临床意义

Changes and clinical significance of serum high sensitivity C-reactive protein in acute cerebral infarction patients with different etiological types.

目的探讨急性脑梗死（ACI）不同病因学亚型患者血清超敏C-反应蛋白（hs—CRP）含量的动态变化及与病情严重程度和预后的关系。方法选择ACI患者136例，按照TOAST分型分为5个亚型。用免疫比浊法检测各组患者发病第1、3、5、7、14天的hs-CRP含量，应用美国国立卫生研究院卒中量表对其神经功能缺损进行标准评分。选取42例健康体检者作为对照组。结果ACI组hs—CRP含量在发病第1、3、5、7、14天明显高于正常对照组[（4．26±1．31）、（12．57±6．29）、（10．23±4．49）、（7．54±2．33）、（4．25±1．77）mg／L与（2．56±0．86）mg／L，t值分别为7．89、10．26、10．99、13．55、5．97，P均〈0．05]。在不同病因学亚型组中，大动脉粥样硬化性卒中组的血清hs—CRP浓度较其他亚型组高，其次为心源性脑栓塞组；卒中后第3、5天血清hs-CRP含量最高，随后逐渐下降；ACI发病第1、3、5、7、14天血清hs—CRP含量在重度神经功能缺损程度组显著高于中度和轻度组（F值分别为5．14、4．29、9．23、4．84、3．59，P均〈0．05）。结论ACI与hs-CRP密切相关，ACI患者hs-CRP含量可作为判断病情及预后的客观指标，hs—CRP越高，持续时间越长，预后越差。

Objective To investigate dynamic changes and clinical significance of the high-sensitive Creactive protein（hs-CRP） level in acute cerebral infarction patients with different etiological types. Methods 136 patients with acute cerebral infarction were recruited. These patients were classified into five subtypes based on Trial of Org 10172 in Acute Stroke Treatment（TOAST） criteria. Serum hs-CRP levels on the 1st,3rd,5th,7th, 14th day after onset from patients and 42 healthy controls were measured with immunoturbidimetry. The neurologic impairment score was determined with NIHSS. Results Serum hs-CRP levels is higher on the 1th,3rd,5th,7th,14th day than that of the control group （ （4. 26 ± 1. 31 ）, （ 12. 57 ± 6. 29 ）, （ 10. 23 ± 4.49）, （7. 54 ± 2. 33 ）, （4. 25 ± 1.77） mg/L and （2. 56 ±0. 86） mg/L,t =7.89,10. 26,10. 99,13.55,5.97 ,P 〈0. 05）. Among 5 subtypes,serum hs-CRP was the highest in large-artery atherosclerosis group after acute ischemic stroke, and cardioembolism group was the next. Serum hs-CRP reached the highest on three or five days after disease onset and decreased slowly. High levels of hs-CRP in large-artery atheroselerosis group indicated severe neurologie functional impairment and worsen prognosis. Conclusions ACI is closely related to serum hs-CRP level,which can be used as an subjective index for severity and prognosis with the lasting, high levels of hs-CRP levels predict poor prognosis.