血清骨保护素水平与急性脑梗死病因亚型及严重程度的关系

Association of serum osteoprotegerin levels with stroke subtypes and severity in patients with acute ischemic stroke

目的探讨急性脑梗死中血清骨保护素（OPG）水平与病情轻重及梗死灶大小的相关性．及其与脑梗死TOAST病因分型之间的关系。方法选择中国医科大学附属盛京医院神经内科自2010年8月至2011年1月收治的急性脑梗死患者62例（病例组）以及同期健康体检者40例f对照组）为研究对象。依据TOAST分型方法将病例组分为大动脉粥样硬化性卒中（LAA）26例和小动脉闭塞性或腔隙性卒中（SAA）36例。收集各组研究对象的临床资料及相关检查结果，并采用酶联免疫吸附双抗夹心测定法（ELISA法）测定血清OPG水平，以进行统计学分析O结果病例组血清OPG水平明显高于对照组，差异有统计学意义（P〈0．05）。Logistic回归分析显示，高血压和血清OPG水平与急性脑梗死的发生有显著相关性（P=-0．004，P=0．002）。病例组血清OPG水平与美国国立卫生研究院卒中量表（NIHSSl评分和梗死灶最大直径呈相关关系（r=0．658，P=0．000；r=0．487，p=0．010）。LAA组血清OPG水平明显高于SAA组和对照组，差异均有统计学意义（p〈0．05），SAA组与对照组血清OPG水平比较差异无统计学意义胗0．05）。结论血清OPG作为一个独立的危险因素参与急性脑梗死的发病，其水平与病情轻重和梗死灶大小相关，与大动脉粥样硬化性卒中关系更加密切。

Objective To investigate the serum osteoprotegerin （OPG） levels in patients with acute ischemic stroke and evaluate the relation of serum OPG levels with stroke severity, focus size and stroke subtypes according to TOAST criteria. Methods The study consisted of 62 patients with acute cerebral infarction （patient group） and 40 control subjects （control group）, collected in our hospital from August 2010 to January 2011. The patient group was sub-divided into large artery atherosclerotic stroke （LAA） group （n=26） and small artery occlusive or lacunar stroke （SAA） group （n=36） in terms of TOAST criteria. Clinical data and examination results were collected. Serum OPG levels were measured with enzyme linked immunoadsorbent assay （ELISA）. Results Serum OPG levels in patients with acute ischemic stroke were significantly higher than those in control subjects （P〈0.05）; Logistic regression analysis showed that hypertension （P=0.004） and serum OPG levels （P=-0.002） exhibited significant correlations with presence of acute cerebral infarction; serum OPG levels were correlated with NIHSS scores （r=0.658, P=-0.000） and maximum diameter of the focus （r=0.487, /9=-0.010） in ischemic stroke group; serum OPG levels in LAA subgroup were significantly higher than those in SAA subgroup and control group （P〈0.05）, and there was no significant difference of serum OPG levels between SAA subgroup and control group （P=0.086）. Conclusions Serum OPG levels may play roles in presence of acute ischemic stroke as independent risk factors. OPG levels are related to the severity of illness and focus size, and especially associated with LAA stroke subtype.