缺血性卒中急性期患者血清半胱氨酸蛋白酶抑制剂C水平的变化

Clinical significance of serum cystatin C in patients with acute ischemic stroke

目的探讨血清半胱氨酸蛋白酶抑制剂C(简称胱抑素C)与缺血性卒中的相关性及临床意义。方法收集急性缺血性卒中患者147例,按病灶体积分为小、中、大3个亚组,根据美国国立卫生研究院卒中量表(NIHSS)分为高危组(NIHSS>8分)和低危组(NIHSS≤8分),选择60例非卒中患者为对照组。采用颗粒增强免疫比浊法测定血清胱抑素C水平,探讨胱抑素C与缺血性卒中的关系,并分析胱抑素C与缺血性卒中的相关性。结果①缺血性卒中组患者血清胱抑素C水平为(1.20±0.40)mg/L,高于对照组的(0.86±0.23)mg/L,差异有统计学意义,P<0.05。随着病灶体积的增加,血清胱抑素C水平也升高,差异有统计学意义,F=10.447,P<0.05。②卒中复发组患者的血清胱抑素C水平为(1.33±0.52)mg/L,高于卒中初发组的(1.12±0.28)mg/L,差异有统计学意义,P<0.01。③血清胱抑素C水平与NIHSS评分无相关性,但高危组患者的胱抑素C水平[(1.37±0.68)mg/L]高于低危组的胱抑素C水平[(1.15±0.27)mg/L],差异有统计学意义,P<0.01。④血清胱抑素C水平与同型半胱氨酸(Hcy,r=0.189,P=0.022)和极低密度脂蛋白(r=0.255,P=0.002)呈正相关,与高密度脂蛋白(r=-0.173,p=0.036)呈负相关;⑤多因素Logistic回归分析显示,血清胱抑素C为缺血性卒中的危险因素(OR=2.646,95%CI.621～4.317,p<0.01)。结论血清胱抑素C水平升高是缺血性卒中的独立危险因素,与缺血性卒中病灶大小及严重程度有关,血清胱抑素C水平可作为缺血性卒中发生、发展及病情监测的参考指标。

Objective To investigate the correlation and clinical significance of serum cystatin C （Cys-C） level and ischemic stroke. Methods A total of 147 patients with acute ischemic stroke were re- cruited. They were divided into small, medium and large sub-groups according to the infarct volume of the brain. They were also divided into high-risk group （ the National Institute of Health Stroke Scale 〉 8 ） and low-risk group （NIHSS ≤ 8 ） according to the scores of NIHSS. Sixty patients without stroke were selected as a control group. A particle enhanced immunoturbidimetric assay was used to detect the serum Cystain C levels, investigate the relationship between Cystain C level and ischemic stroke and analyze the correlation between Cystain C level. Results ①The serum Cystain C level 1.20± 0.40mg/L in the ischemic stroke group was significantly higher than 0.86 ± 0.23 mg/L in the control group. The difference was statistically significant （P 〈 0.05）. With the increase in infarct volume, the serum Cystain C level also increased. The difference was statistically significant （ P 〈 0.05 ）. ②The serum Cystain C level 1.33± 0.52 mg/L in a stroke recurrence group was higher than 1.12 ± 0.28 mg/L in a initial stroke group. The difference wasstatistically significant （ P 〈 0.01 ）. ③The serum Cystain C level has no correlation with the NIHSS score, but the serum Cystain C level 1.37 ±0.68 mg/L in the high risk group was higher than 1.15 ±0.27 in the low risk group. The difference was statistically significant （ P 〈 0.01 ）. ④The serum Cystain C level was positively correlated with homocysteine （Hcy） （r = 0. 189, P = 0. 022 ） and very low density lipoprotein cholesterol （ VLADL-C ） （ r = 0. 255, P = 0. 002 ） , however, it was negatively correlated with high density lipoprotein cholesterol （HDL-C） （ r = - 0. 173, P = 0. 036）. ⑤Multivariate logistic regression analysis showed that the serum Cystain C was a risk factor for ischemic stroke （ OR = 2. 646, 95% CI 1. 621 - 4. 317, P 〈0.01）. Conclusion The increased serum Cystain C level is an independent risk factor for ischemic stroke, it is associated with the lesion size and the severity of cerebral infarction. The serum level may be used as a reference indicator for the occurrence and development of cerebral infarction and disease surveillance.