超敏C反应蛋白在脑梗死病因分型中的价值

THE VALUE OF HIGH-SENSITIVITY C-REACTIVE PROTEIN IN ETIOLOGIC TYPING OF CEREBRAL INFARCTION

目的探讨超敏C反应蛋白（Hs-CRP）在不同病因所致的脑梗死病人中的水平变化及其在病因诊断中的价值。方法选择急性脑梗死病人,通过记录病史及相关辅助检查,按照TOAST以及改良的TOAST病因分型方法进行分类,并比较两种分型方法各型的构成比及各型病人的Hs-CRP水平。结果急性脑梗死病人按照TOAST分型,以LAA型最多（39.4%）,然后依次为SAD型（30.9%）、SUD型（23.9%）、CE型（3.9%）,SOD型最少（1.9%）;按照改良TOAST分型,AT型最多（58.3%）,然后依次为SAD型（21.6%）、SUD型（15.1%）、CE型（3.1%）、SOD型（1.9%）。改良后方法使SUD型减少,AT型显著增多。两种分型方法的各型病人Hs-CRP水平明显高于对照组（F=27.64、25.32,q=4.06~12.61,P〈0.01）,在脑梗死中以CE型Hs-CRP水平最高,显著高于其他各型,LAA型或AT型显著高于SAD型（q=2.90~9.27,P〈0.05、0.01）。结论改良的TOAST病因分型能较全面地对脑梗死进行分型,减少不明原因的脑梗死病人。Hs-CRP水平在不同病因的脑梗死中明显不同,可作为脑梗死病因分型的依据之一。

Objective To detect the levels of high sensitivity C-reactive protein（Hs-CRP） and its value in etiological diagnosis for different-cause cerebral infarction（CI）. Methods Acute patients with CI were selected,their history and auxiliary examinations recorded,etiologic typing was carried out based on TOAST and modified TOAST.The constituent ratio of the two typing methods and Hs-CRP levels of different type patients were compared. Results TOAST method,the most popular type of acute CI was LAA（39.4%）,followed by SAD（30.9%）,SUD（23.9%）,CE（3.9%） and SOD（1.9%）;According to the modified TOAST,the most popular type was AT（58.3%）,came next were SAD（21.6%）,SUD（15.1%）,CE（3.1%） and SOD（1.9%）.With the modified method,types of unknown causes decreased,and type AT increased.The levels of Hs-CRP in patients of different types classified by two TOAST methods were markedly higher than that of the control（P0.01）.In CI,the levels of Hs-CRP were the highest in type CE,and type LAA or AT was manifestly higher than SAD（P0.05）. Conclusion The modified TOAST etiological typing may comparatively and roundly classify CI,reduce the number of CI patients with unknown causes.The levels of Hs-CRP are obviously different in patients of various origins,which can be used as one of the evidences for etiological grouping of CI.