急性脑梗死患者血清心肌酶学改变及危险因素分析

Analysis of changes in serum creatine kinase and its risk factors in acute cerebral infarction

目的观察急性脑梗死(ACI)患者血清心肌酶学的改变,并分析其危险因素。方法选取115例ACI患者,入院确诊后均给予相应的治疗措施,收集患者一般资料,内容包括性别、年龄、主要病史(高血压、糖尿病、脑血管病),对相关因素进行Logistic分析,在患者入院后72h内进行标准12导联心电图检查,并采血进行心肌酶学检测(检测指标:CK、CK-MB、AST、LDH)。同时对2组患者神经功能缺损程度及短期预后进行比较,并对其与患者心肌酶水平之间的关系进行分析,神经功能缺损程度采用NIHSS评分进行评定,短期预后采用mRS(自我生活自理能力)评定。结果 115例患者中,血清心肌酶升高20例,正常95例;血清心肌酶升高组CK、CK-MB、AST、LDH均明显高于正常组(P<0.05)。单因素Logistic分析显示,高血压史、糖尿病史、TC、TC、LDL-C、纤维蛋白原是ACI患者血清心肌酶学改变的危险因素(P<0.05),其中以高血压史、LDL-C升高、HDL-C降低影响更为显著。将ACI患者血清心肌酶学改变的危险因素进一步校正,结果显示高血压史(OR=2.56,P<0.05)、LDL-C升高(OR=2.68,P<0.05)是ACI患者心肌酶学改变的独立危险因素。心肌酶升高组发病后第1、3、7天NIHSS评分、mRS评分均明显高于正常组(P<0.05)。结论 ACI患者血清心肌酶升高的危险因素包括高血压史、高血脂史、糖尿病史等,而心肌酶越高,预后越差,应对采取必要的干预措施。

Objective To observe the changes in serum creatine kinase for patients with acute cerebral infarction （ACI） and analyze the risk factors .Methods 115 cases of ACI patients diagnosed after enrollment were given appropriate treatment.We collected some items including gender ,age ,major history （hyper‐tension ,diabetes ,cerebrovascular disease） ,and logistic analysis of the relevant factors was applied.12‐lead ECG was conducted in all patients after admission within 72h and serum creatine kinases mainly including CK ,CK‐MB ,AST ,LDH were detec‐ted. Neurological deficit scale（NDS） and short‐term prognosis were analyzed in the two groups ,and the relationship between which and cardiac enzyme levels was estimated.NDS was assessed using the NIHSS ,short‐term prognosis was assessed by mRS （self‐living skills ）.Results serum enzymes were elevated in 20 cases among 115 patients ,and 95 cases with normal serum en‐zymes ,CK ,CK‐MB ,AST ,LDH serum enzymes in elevation group were significantly higher than those in normal group （P〈0.05 ）. Univariate logistic regression analysis revealed that history hypertension ,diabetes ,TC ,LDL‐C ,fibrinogen were risk fac‐tors（P〈0.05）. The result showed that hypertension （OR=2.56 ,P〈0.05） ,LDL‐C elevation （OR=2.68 ,P〈0.05） were in‐dependent risk factors after rectification. The NIHSS scores and mRS scores at 1d ,3d ,7d in elevation group were significantly higher than those in normal group（P〈0.05）.Conclusion The risk factors of elevated serum enzyme include hypertension ,high cholesterol ,diabetes ,etc.And the higher the cardiac enzymes are ,the worse the prognosis.So the necessary interventions should be taken for patients.