血清神经肽Y和皮质醇水平在预测脑梗死患者发生恶性脑梗死中的价值

Dredictive value of serum levels of cortisol and neuropeptide Y in predicting malignant cerebral infarction in patients with cerebral infarction

目的探讨血清神经肽Y(NPY)和皮质醇(Cor)水平在预测脑梗死患者发生恶性脑梗死中的价值。方法选取大脑半球大面积脑梗死患者95例,收集临床资料,根据临床症状及脑CT检查结果将患者分为恶性大脑中动脉脑梗死(MMI)和非MMI,检测血清NPY和Cor水平,利用受试者工作特征曲线(ROC)对血清NPY和Cor水平在预测发生MMI中的价值进行分析。结果 MMI患者发热、恶性呕吐和烦躁比例均高于非MMI患者,差异均有统计学意义(P<0.05);MMI患者血清NPY和Cor水平均高于非MMI,差异均有统计学意义(P<0.05);ROC曲线分析显示,血清NPY水平在预测发生MMI时,曲线下面积0.749(95%CI:0.636~0.862),当血清NPY=175.4 ng/L时,灵敏度72.1%,特异度73.5%,血清Cor水平在预测发生MMI时,曲线下面积0.851(95%CI:0.754~0.948),当血清Cor=40.5μg/L时,灵敏度86.9%,特异度82.4%,二者联合时,曲线下面积0.926(95%CI:0.870~0.983),灵敏度93.4%,特异度79.4%。结论 MMI患者血清NPY和Cor水平升高,联合检测血清NPY和Cor有助于早期鉴别诊断MMI。

Objective To investigate the diagnostic value of serum levels of cortisol （ Cor ） and neuropeptide Y （ NPY） in predicting malignant cerebral infarction in patients with cerebral infarction .Methods The clinical data about 95 patients with hemisphere massive cerebral infarction were collected .According to clinical symptoms and brain CT findings ,the patients were divided into malignant middle cerebral artery infarction goup （ MMI group ） and non-MMI group.The serum levels of NPY and Cor were detected ,and receiver operating characteristic curve （ ROC） was used to evaluate the diagnostic value of serum levels of NPY and Cor in predicting occurrence of MMI .Results The proportions of fever,nausea,vomiting and irritability in MMI group were significantly higher than tose in non-MMI group （ P 〈0.05）.The serum levels of NPY and Cor in MMI group were significantly higher than those in non-MMI group.ROC curve analysis showed that the area under curve for the serum levels of NPY in predicting the occurrence of MMI was 0.749 （95% CI：0.636~0.862）, during the serum NPY=175.4ng/L,the sensitivity and specificity were 72.1%,73.5%, respectively, and for the serum levels of Cor , the area under curve was 0.851 （95%CI：0.754~0.948）,during the serum Cor=40.5μg/L,the sensitivity and specificity were 86.9%,82.4%,respectively,however, during combining the two factors ,the area under curve was 0.926 （95% CI：0.870~0.983）, sensitivity and specificity were 93.4%,79.4%,respectively.Conclusion The serum levels of NPY and Cor in patients with MMI are increased ,and combination detection of two factors is helpful to the early diagnosis of MMI .