血浆超敏C反应蛋白和脂蛋白（a）水平在缺血性卒中新TOAST分型诊断中的鉴别作用

Identification role of plaslra high sensitive C-reactive protein and lipoprotein （a） levels in the diagnosis of ischele stroke according to the TOAST classification

目的探讨急性缺血性卒中患者血浆超敏C反应蛋白（high—sensitive C-reactiveprotein，hs—CRP）和脂蛋白（a）[Lipoprotein（a），Lp（a）]水平在新TOAST分型诊断中的鉴别作用。方法分别采用免疫散色比浊法和免疫透射比浊法检测82例急性缺血性卒中患者（〈24h）和60例健康对照者的血浆hs—CRP和Lp（a）水平，并尽可能完成动态心电图、超声心动图、MRI、磁共振血管造影／CT血管造影傲字减影血管造影等辅助检查，最后根据缺血性卒中新TOAST分型诊断标准对其进行分型。结果急性缺血性卒中患者各亚型及对照组血浆hs—CRP和Lp（a）水平存在显著差异（P均〈0．001），其中心源性栓塞（cardioembolism，CE）患者血浆hs-CRP水平最高。hs-CRP可作为CE亚型的一个生物学标记物（优势比1．84，95％可信区间1．18～2．85；P〈0．05）；当其浓度〉3．48m；皿时，预测CE的敏感性和特异性分别为89％和83％。AT患者血浆Lp（a）水平最高，可作为AT亚型的一个生物学标记物（优势比1．02，95％可信区间1．01～1．03；P〈0．05）；当其浓度〉183．5mgm时，其预测AT的敏感性和特异性分别达87％和85％。结论急性缺血性卒中患者血浆hs—CRP和Lp（a）水平可为及时准确的病因学分型提供一定的帮助。

Objective To investigate the identification role of plasma high sensitive C- reactive protein （hs-CRP） and lipoprotein （a） （Lp [ a] ） levels in the diagnosis of patients with acute ischemic stroke according to the TOAST classification. Methods The levels of plasma hs- CRP and Lp （a） in 82 acute stroke patients （ 〈24 hours） and 60 healthy controls were detected using immune scatter turbidimetry and immune transmission turbidity, and try to make use of Holter, ultrasonography, magnetic resonance imaging, magnetic resonance angiography/CT angiography/dagital subtraction angiography and other tests. Finally, they were classified according to the diagnostic criteria of the TOAST classification of ischemic stroke. Results There were significant differences in plasma hs-CRP and Lp （a） levels between all the subtypes of the acute ischemic sroke group and the control group （all P 〈 0. 001 ）. The the level of plasma hs-CRP in patients with cardioembolism （CE） was highest. Hs-CRP could be used as a biological marker of CE subtype （odds ratine OR] = 1.84, 95% confidence interval [ CI] 1.18-2. 85, P 〈 0. 05）. When its concentration was 〉 3.48 mg/L, the sensitivity and specificity of predicting CE were 89% and 83% respectively. The plasma level of the AT patients was highest, it could be used as a biological marker of AT subtype （OR = 1.02, 95% CI 1.01-1.03, P 〈 0. 05）; when its concentration was 〉 183.5 mg/L, the sensitivity and specificity of predicting AT were 87% and 85% respectively. Conclusions The plasma hs-CRP and Lp （a） levels of patients with acute ischemic stroke may provide some help for timely and accurate etiological typing,