血浆α2巨球蛋白水平与小动脉闭塞型脑梗死发病及认知功能的关系

Correlations of plasma alpha2-macroglobulin levels with small-artery occlusion and cognitive function

目的 探讨血浆α2巨球蛋白（α2-MG）水平与小动脉闭塞型（SAO）脑梗死发病及认知功能的关系.方法 在青岛大学附属医院神经内科自2012年12月至2013年9月收治的患者中选取符合TOAST分型中SAO型脑梗死患者58例（SAO组）、大动脉粥样硬化型（LAA）脑梗死患者56例（LAA组）以及同期体检健康的正常者53例（健康对照组）,应用酶联免疫吸附测定法（ELISA）检测血浆α2-MG水平并比较组间差异,绘制受试者工作特征曲线（ROC）判断血浆α2-MG水平对SAO型脑梗死的诊断价值.同时对SAO组进行简易精神状态量表（MMSE）测评,并对其颅脑MRI进行Fazekas评分评判脑白质损害（WMLs）程度,比较不同WMLs程度患者血浆α2-MG水平差异,分析血浆α2-MG水平与MMSE量表评分及Fazekas评分的相关性.结果 与LAA组[（5.04±1.93） μg/mL]、健康对照组[（4.86±1.68） μg/mL]相比,SAO组血浆α2-MG水平[（6.70±3.17）μg/mL]明显增高,差异均有统计学意义（P＜0.05）;二元Logistic回归分析显示血浆α2-MG水平是SAO型脑梗死的独立危险因素（OR=1.409,P=0.001;OR=1.443,P=0.004）.ROC曲线显示4.23μg/mL α2-MG水平为诊断SAO型脑梗死的最佳临界值,灵敏度可达86.2％.不同WMLs程度的SAO型脑梗死患者间血浆α2-MG水平差异有统计学意义（F=26.509,P=0.000）,且血浆α2-MG水平与Fazekas评分呈正相关（r=0.733,P=0.000）,与MMSE量表评分呈负相关（r=-0.679,P=0.000）.结论 α2-MG可作为诊断SAO型脑梗死的血浆标志物,是其独立危险因素,且其水平与认知功能障碍程度及WMLs程度密切相关.

Objective To investigate the relationships of plasma alpha2-macroglobulin （α2-MG） level with occurrence of small-artery occlusion （SAO） and cognitive function in SAO patients.Methods Subjects were collected in our hospital from December 2012 to September 2013;58 patients with SAO stroke,56 with large artery atherosclerosis （LAA） classified by Trial of Org 10172 in Acute Stroke Treatment （TOAST）,as well as 58 healthy controls,were enrolled.The serum α2-MG levels were measured by enzyme-linked immunosorbent assay （ELISA） and compared among the three groups.The receiver operating characteristic （ROC） curve was drawn to evaluate the value of α2-MG as a biomarker for SAO.White matter lesions （WMLs） were assessed by MRI using Fazekas classification,and mini-mental state examination （MMSE） was used to evaluate the cognitive function.The correlations of plasma α2-MG level with both Fazekas scores and MMSE scores were analyzed.Results The serum α2-MG levels in SAO patients （[6.70±3.17] μg/mL） were significantly higher than those in LAA patients （[5.04±1.93] μg/mL） and controls （[4.86±1.68] μg/mL） （P〈0.05）.Binary Logistic regression analysis showed that the plasma α2-MG level was an independent risk factor for occurrence of SAO （OR=1.409,P=0.001;OR=1.443,P=0.004）.The ROC curves obtained that α2-MG=4.23 μg/mL was the cutoff values for SAO,enjoying sensitivity up to 86.2%.SAO patients with different severities of WMLs had significantly different serum α2-MG levels （F=26.509,P=0.000）;the serum α2-MG levels were positively correlated with Fazekas scores （r=0.733,P=0.000） and negatively correlated with MMSE scores （r=-0.679,P=0.000）.Conclusions Serum α2-MG level is an independent risk factor for SAO and might be a biomarker for SAO.Furthermore,serum α2-MG level,being associated with high-grade WMLs,might contribute to evaluating the cognitive impairment in SAO patients.