2种不同检测系统测定血清Lp(a)水平在急性缺血性脑梗死中的应用

Application of two different detection systems in determination of lipoprotein( a) for patients with acute ischemic cerebral infarction

目的评价2种检测系统测定血清脂蛋白（a）[Lp（a）]水平诊断急性缺血性脑梗死的效能。方法选取2015年1-6月在山东省聊城市人民医院住院的急性缺血性脑梗死患者147例,分别用检测系统1（以mg/L为单位）和检测系统2（以nmol/L为单位）对患者血清中的Lp（a）水平进行检测,通过ROC曲线评价2种检测系统检测血清Lp（a）水平对急性缺血性脑梗死的诊断效能;按照美国国立卫生研究所卒中量表对急性缺血性脑梗死患者进行神经功能缺损程度评估（NIHSS评分）,分析2种检测系统检测血清Lp（a）水平与NIHSS评分之间的关系。结果检测系统1与检测系统2的检测值均高于对照组,且均有统计学意义（P均〈0.01）。检测系统2测定Lp（a）对诊断急性缺血性脑梗死的敏感性和特异性均显著高于检测系统1：检测系统1诊断急性缺血性脑梗死的AUC为0.801（95%CI：0.728-0.874）,最佳cut off值为168.05 mg/L,敏感性为71.1%,特异性为61.9%;检测系统2诊断急性缺血性脑梗死AUC为0.919（95%CI：0.877-0.961）,最佳cut off值为19.95 nmol/L,敏感性为78.7%,特异性为95.2%。检测系统2检测Lp（a）结果相对于检测系统1,与急性缺血性脑梗死患者的神经功能缺损程度有更好的相关性（检测系统1：r=0.462,检测系统2：r=0.587）。结论用检测系统2检测血清中Lp（a）的水平对急性缺血性脑梗死患者的诊断价值优于检测系统1。

Objective To evaluate the efficacy of two kinds of detection systems for determination of lipoprotein（ a） [Lp（ a） ]in prediction of acute ischemic cerebral infarction. Method A retrospective study was conducted on 147 patients with acute ischemic cerebral infarction in Liaocheng People＇ s Hospital from January to June of 2015,in which two detection system,i. e.,1（ indicated by mg / L） and 2（ indicated by nmol / L）,were used to measure the levels of Lp（ a） in serum of the patients. The efficiencies in forecasting acute ischemic cerebral infarction of the two detection systems were evaluated through receiver operating characteristic（ ROC）curve,and the degrees of neurological deficit were assessed according to US National Institute of Health Stroke Scale（ NIHSS score）.The relationship between the levels of Lp（ a） determined by the two systems and the scores of NIHSS were analyzed. Results The measured values of the both systems were higher than those of the control group,and the differences were statistically significant（ all P〈0. 01）. The sensitivity and specificity of the Detection System 2 in forecasting acute ischemic cerebral infarction were significantly higher than those of Detection System 1. The AUC of Detection System 1 in forecasting acute ischemic cerebral infarction was 0. 801（ 95% CI： 0. 718-0. 874）,optimal cut-off value was 168. 05 mg/L,sensitivity was 71. 1%,and specificity was 61. 9%,while the AUC of Detection System 2 was 0. 919（ 95% CI： 0. 877-0. 961）,optimal cut off value was 19. 95 nmol / L,sensitivity was 78. 7%,specificity was 95. 2%. The Detection System 2 showed better correlation of Lp（ a） levels with the degrees of neurological deficit（ r =0. 587） than that of Detection System 1（ r = 0. 462）. Conclusion The predictive value of Detection System 2 for acute ischemic cerebral infarction should be higher than that of Detection System 1.