血清胆碱酯酶水平与急性脑梗死患者病情严重程度及预后的关系研究

Correlations of Serum Cholinesterase Level with Severity and Prognosis in Patients with Acute Cerebral Infarction

目的探讨血清胆碱酯酶(CHE)水平与急性脑梗死患者病情严重程度及预后的关系。方法选取2012—2016年上海市松江区方塔中医医院收治的急性脑梗死患者90例,根据美国国立卫生研究院卒中量表(NIHSS)评分分为A组(NIHSS评分≥5分,n=44)与B组(NIHSS评分<5分,n=46);根据改良Rankin量表(mRS)评分分为预后良好组(mRS评分0~2分,n=41)与预后不良组(mRS评分3~6分,n=49)。比较A组与B组患者血清CHE水平,血清CHE水平与急性脑梗死患者NIHSS评分的相关性分析采用Pearson相关性分析;比较预后良好组与预后不良组患者临床资料,急性脑梗死患者预后的影响因素分析采用多因素Logistic回归分析。结果 A组患者血清CHE水平低于B组(P<0.05)。Pearson相关性分析结果显示,血清CHE水平与急性脑梗死患者NIHSS评分呈负相关(r=-0.436,P<0.05)。预后良好组与预后不良组患者性别、收缩压(SBP)、舒张压(DBP)及血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、纤维蛋白原(FIB)水平比较,差异无统计学意义(P>0.05);预后不良组患者年龄大于预后良好组,NIHSS评分、空腹血糖(FPG)及血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)水平高于预后良好组,血清CHE水平低于预后良好组(P<0.05)。多因素Logistic回归分析结果显示,年龄[OR=1.99,95%CI(1.66,2.39)]、NIHSS评分[OR=3.77,95%CI(2.59,5.48)]、FPG[OR=3.01,95%CI(1.99,4.54)]是急性脑梗死患者预后良好的危险因素,血清CHE水平[OR=0.92,95%CI(0.88,0.96)]是急性脑梗死患者预后良好的保护因素(P<0.05)。结论血清CHE水平与急性脑梗死患者病情严重程度有关,年龄、NIHSS评分、FPG是急性脑梗死患者预后良好的危险因素,血清CHE水平是急性脑梗死患者预后良好的保护因素。

Objective To investigate the correlations of serum cholinesterase level with severity and prognosis in patients with acute cerebral infarction. Methods From 2012 to 2016,a total of 90 patients with acute cerebral infarction were selected in Fangta Traditional Chinese Medicine Hospital of Songjiang District,and they were divided into A group（ with NIHSS score equal or over 5,n = 44） and B group（ with NIHSS score less than 5,n = 46） according to NIHSS score,into C group（ with good prognosis,mRS score was 0 to 2,n = 41） and D group（ with poor prognosis,mRS score was 3 to 6,n = 49）according to mRS score. Serum cholinesterase level was compared between A group and B group,and Pearson correlation analysis was used to analyze the correlation between serum cholinesterase level and NIHSS score in patients with acute cerebral infarction;clinical data was compared between C group and D group,and multivariate Logistic regression analysis was used to analyze the influencing factors of prognosis in patients with acute cerebral infarction. Results Serum cholinesterase level of A group was statistically significantly lower than that of B group（ P〈0. 05）. Pearson correlation analysis results showed that, serum cholinesterase level was negatively correlated with NIHSS score in patients with acute cerebral infarction（ r =-0. 436,P〈0. 05）. No statistically significant differences of gender, SBP, DBP, serum level of TC, TG, HDL-C, LDL-C or FIB was found between C group and D group（ P〉0. 05）; age of D group was statistically significantly older than that of C group,NIHSS score,FPG,serum levels of homocysteine and CRP of D group were statistically significantly higher than those of C group,while serum cholinesterase level of D group was statistically significantly lower than that of C group（ P〈0. 05）. Multivariate Logistic regression analysis results showed that, age [OR = 1. 99,95% CI（ 1. 66,2. 39） ], NIHSS score [OR = 3. 77,95% CI（ 2. 59,5. 48） ]and FPG [OR = 3. 01,95% CI（ 1. 99,4. 54） ] were risk factors of good prognosis in patients with acute cerebral infarction,while serum cholinesterase level [OR = 0. 92,95% CI（ 0. 88,0. 96） ] was the protective factor（ P〈0. 05）. Conclusion Serum cholinesterase level is significantly correlated with the severity in patients with acute cerebral infarction,age,NIHSS score and FPG are risk factors of good prognosis in patients with acute cerebral infarction,while serum cholinesterase level is the protective factor.