VILIP-1和 NR2多肽联合检测在早期缺血性脑卒中的临床诊断价值

The diagnostic value of VILIP-1 and NR2 peptide combined detection in the early ischemic stroke

目的：探讨缺血性脑卒中患者血清中视锥蛋白样蛋白1（VILIP-1）和N-甲基-D-门冬氨酸受体（ NMDA-R）裂解产物NR2多肽水平，并探讨其早期诊断的临床价值。方法采用病例对照研究，选取可疑短暂性脑缺血发作（ TIA，出现症状24 h内）或急性缺血性脑卒中（ IS，出现症状72 h内）患者340例、健康体检者102名、有血管危险因素的对照者98例和出血性脑卒中患者35例作为研究对象，利用ELISA检测血清中VILIP-1和NR2多肽的水平。各组间VILIP-1和NR2多肽水平采用非参数秩和检验进行差异分析，并对VILIP-1和NR2多肽水平进行组间的独立和联合诊断性能分析。结果 IS组血清中的VILIP-1和NR2多肽浓度分别为9.80（1.90～14.22）μg/L 和14.40（5.60～27.91）μg/L，显著高于健康对照组[ VILIP-1：0.02（0.01～0.09），NR2：0.33（0.02～1.15），χ2＝5.61、9.54，P＜0.001]、血管高危因素组[VILIP-1：0.03（0.02～0.16），NR2：0.27（0.01～1.54），χ2＝6.74、10.62，P＜0.001]和非脑卒中组[VILIP-1：0.04（0.03～0.19），NR2：0.53（0.45～1.21），χ2＝3.78、7.63，P＜0.001]。 VILIP-1和NR2多肽浓度在发病的最初3 h内显著升高。 NR2多肽浓度在IS组明显高于出血性脑卒中组[0.47（0.23～1.32）μg/L]，曲线下面积（AUC）为0.934，具有较强的诊断性能。 VILIP-1和NR2多肽联合检测区分IS与其他对照者时，AUC为0.974，显著高于单独检测VILIP-1（AUC＝0.849）和NR2（AUC＝0.862）的结果。结论 VILIP-1和NR2多肽是早期诊断IS比较敏感和特异的指标，二者联合应用可以提高IS患者早期的诊断率。（中华检验医学杂志，2014，37：469-472）

Objective To Investigate the concentration of VILIP-1 and NR2 peptide in the serum of patients with ischemic stroke , and to explore their clinic value in early diagnostic of ischemic stroke patients.Methods The levels of VILIP-1 and NR2 peptide were examined by ELISA （ enzyme linked immunosorbent assay ,ELISA） with suspicious TIA （ defined as a neurological deficit that resolved within 24 hours） or acute ischemic stroke patients （ within 72 hours of onset of symptoms ） 340 cases,102 healthy controls,98 patients with vascular risk factors and 35 patients with hemorrhagic stroke.Among all the groups , VILIP-1 and NR2 peptide level were analyzed using the nonparametric Wilcoxon test.Diagnostic performance were analyzed among the groups with the two biomarkers independently and combinedly .Results Serum levels of VILIP-1 and NR2 peptide in patients with ischemic stroke （IS） were 9.80 （1.90-14.22） μg/L, 14.40 （5.60-27.91） μg/L respectively,which was higher than that of the healthy control group [VILIP-1：0.02 （0.01-0.09）,NR2：0.33 （0.02-1.15）,χ2 were 5.61 and 9.54,P〈0.001],the group with vascular risk factors [VILIP-1：0.03 （0.02-0.16）,NR2：0.27 （0.01-1.54）,χ2 were 6.74 and 10.62,P〈0.001], the group of patients non-stoke [VILIP-1：0.04 （0.03-0.19）,NR2：0.53 （0.45-1.21）,χ2 were 3.78 and 7.63, P 〈0.001 ].The levels of VILIP-1 and NR2 peptide was significantly increased in IS patients＆nbsp;presenting within 3 h of symptom onset.When differentiating IS from patients with hemorrhagic stroke ,NR2 had a AUC of 0.934,showing a strong distinguishing effectiveness.Differentiating IS from healthy controls , patients with vascular risk factors and non-stroke patients,the AUC of combination of VILIP-1 and NR2 was 0.974,which was higher than the AUC of either VILIP-1（0.849） or NR2（0.862） alone（P 〈0.05）. Conclusions VILIP-1 and NR2 peptide are very sensitive and specific biomarkers to the early diagnosis of IS.The combination of VILIP-1 and NR2 peptide has higher value of clinical applications than one of them independently.