血清神经元特异性烯醇化酶与同型半胱氨酸在缺血性脑卒中病情评估中的应用

Clinical Significance of Serum Neuron-specific Enolase and Homocysteine Levels in Cerebral Ischemic Stroke Patients

目的:观察缺血性脑卒中(CIS)患者发病早期神经元特异性烯醇化酶(NSE)和同型半胱氨酸(Hcy)含量,及其与神经功能缺损评分的相关性。方法 :收集我院附属医院内科2011年1月至2015年11月收治的CIS初发患者278例(CIS组),按照梗死面积大小,分大面积组(55例)、中面积组(49例)、小面积组(39例)及腔隙性组(135例),最终确定为进展性脑卒中98例,并选择健康体检人群260例做为对照组。利用酶联免疫与荧光偏振免疫分析法分别检测各CIS组与对照组NSE和Hcy含量,并检测进展性脑卒中(SIP)发病2d、3d时的NSE和Hcy含量,同时分析两者与对应神经功能缺损评分(NIHSS)的相关性。结果:各组脑卒中患者的NSE含量均较对照组显著升高(P<0.01);Hcy含量也明显高于对照组(P<0.01或<0.05);各CIS组间分别比较NSE、Hcy含量及NIHSS评分,差异均有统计学意义(P<0.05);各CIS组NIHSS评分与相应NSE、Hcy含量呈正相关;SIP患者,第2、3天NSE分别为(28.5±9.7)μg/L、(33.6±11.7)μg/L,差异有统计学意义(P<0.05),第2、3天NIHSS评分差异有显著性意义(P<0.01),而第2、3天的Hcy含量比较无统计学意义(P>0.05)。结论 :在缺血性脑卒中患者发病早期,血清NSE与Hcy含量可用于判断患者脑梗死面积与神经元损伤程度,且NSE在反映微小损伤时比Hcy更加敏感。

Objective： To investigate the level of serum neuron-specific enolase （NSE） and homocysteine （Hcy）, to study the relationship between the NSE, Hcy and National Institute of Health stroke scale （NIHSS） in cerebral ischemic stroke （CIS） patients. Methods： The level of serum NSE and Hcy were measured respectively using Enzyme-Linked Immunosorbnent Assay and fluorescence polarization y in the 278 primary CIS patients （CIS group, including the 98 stroke in progression） and control group （consists of 260 individuals admitted for the routine checkup）. The levels of them were compared among subgroups which were divided according to the infarcted size （55 massive infarct,49 moderate infarct, 39 small infarct and 135 lacunar infarct）. The relationship between NSE, Hcy and NIHSS was observed. Results： The level of serum NSE in CIS groups were significantly higher than that in the control group （P〈0.01）; There were significant differences of serum Hcy concentration among different subgroups and control gruop （P〈0.05 or P〈0.01） ; There were statistical differences of NSE and Hcy among different subgroups （P〈0.05）; The levels of serum NSE and Hcy were positively related with the NIHSS; The serum level NSE of stroke in progression in 3d were great higher than that in 2 d （P〈0.05）, as well as the NIHSS （P〈0.01）. Conclusion： the Serum NSE and Hcy levels can provide the valuable guidance on disease assessment for the CIS patients and the serum NSE was more sensitive than Hcy in reflecting the extent of cerebral lesions.