急性脑梗死患者血清心肌酶学变化的临床意义及相关危险因素分析

Clinical Significance of Changes of Serum Myocardial Enzymes in Patients with Acute Cerebral Infarction and Its Relative Risk Factors

目的:探讨急性脑梗死患者血清心肌酶学变化与预后的关系及导致急性脑梗死患者心肌酶学变化的相关危险因素。方法:回顾性分析临床及影像资料齐全且确诊的140例急性脑梗死患者(发病14天内),根据有无血清心肌酶学升高分为血清心肌酶学升高的急性脑梗死组A组(43例),血清心肌酶学正常的急性脑梗死组B组(97例),应用美国国立卫生研究院卒中量表评分(NIHSS)比较两组神经功能缺损情况,并对两组病人血清心肌酶学(包括天冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、血糖、血脂、纤维蛋白原和血压等结果进行分析。结果:A组(31%)患者血清心肌酶学均增高,与B组比较均有显著性差异(P<0.01);发病后1天A、B两组患者临床神经功能缺损程度评分无显著性差异,发病后4、8、10天A、B两组患者临床神经功能缺损程度评分有显著性差异(P<0.01);A组高血压、糖尿病与B组比较有显著性差异(P<0.05);而血脂及纤维蛋白原两组比较无显著性差异。结论:急性脑梗死患者血清心肌酶学升高者预后不良;高血压、糖尿病是急性脑梗死患者血清心肌酶学升高的相关危险因素。

Objective： To investigate the relationship between the changes of serum myocardial enzymes in patients with acute cerebral infarction and prognosis of the disease, and explore the risk factors which lead to the changes of myocardial enzymes. Methods： 140 patients diagnosed as acute cerebral infarction within 14 days by clinical and imaging data, were analyzed retrospectively. According to the level of serum myocardial enzymes, 43 patients with increased level of myocardial enzymes constituted group A and another 97 patients with normal level of myocardial enzymes were categorized into group B. Neurological deficits between the two groups were evaluated according to National Institutes of Health Stroke Scale （NIHSS）,and the result of serum myocardial enzymes （including AST, CK, CK-MB, LDH）, glucose, lipid, fibrinogen, and blood pressure were analyzed at the same time. Results： The serum myocardial en- zymes of the patient in group A was significantly higher than group B （p0.01）. No significant difference was found on clinical neurolog- ical deficit of the patients one day after onset （p0.05）, while it was significantly different 4, 8, 10 days after onset （p0.01）. There was 34 patients with hypertension in group A and 38 in group B; 25 patients with diabetes in group A and 29 in group B and both of them were significantly different （p0.05）; while blood lipid and fibrinogen of the two groups were not significantly different （p0.05）. Conclusions： The increase of serum myocardial enzymes in patients with acute cerebral infarction possibly indicates a bad prognosis. Both hyperten- sion and diabetes are relative risk factors for increase of myocardial enzymes in patients with acute cerebral infarction.