急性脑梗死患者Cathepsin S/Cystatin C水平与动脉斑块性质及狭窄程度的相关性分析

Analysis of the relationship between Cathepsin S/Cystatin C and the stenosis degree and arterial plaque characterization of carotid artery in a cohort of IS patients

目的探讨急性脑梗死患者血清组织蛋白酶S(Cat S)与胱抑素C(Cys C)表达水平与动脉斑块性质及狭窄程度的关系。方法 336例急性脑梗死患者根据斑块性质及血管狭窄程度分为:稳定斑块组与不稳定斑块组及轻度、中度和重度狭窄3个亚组;114例同期健康体检者为正常对照组。所有入组患者检测血清Cat S和Cys C,脑梗死患者行神经功能缺损评价。结果脑梗死组患者血清Cat S及Cat S/Cys C均高于对照组,而血清Cys C水平降低,Cat S分别为(63.07±20.81)pg/ml、(50.49±10.54)pg/ml,Cat S/Cys C分别为(78.83±6.88)、(47.18±3.32),Cys C分别为(0.80±0.11)mg/L、(1.07±0.83)mg/L,两组比较,差异均有统计学意义(P<0.05);不稳定斑块组Cat S及Cat S/Cys C较稳定斑块组增高,而血清Cys C水平较稳定斑块组降低,Cat S分别为(75.34±15.45)pg/ml、(60.12±18.53)pg/ml,Cat S/Cys C分别为(103.68±2.52)、(64.64±9.24),Cys C分别为(0.73±0.62)mg/L、(0.93±0.53)mg/L,两组比较,差异均有统计学意义(P<0.05);两组亚组间(轻度狭窄组、中度狭窄组及重度狭窄组)比较,Cat S、Cys C水平及Cat S/Cys C均有显著差异(P<0.05),而血管狭窄程度越重,Cat S及Cat S/Cys C增高越明显、Cys C降低越明显,差异均有统计学意义(P<0.01)。结论脑梗死患者颈动脉斑块稳定性越差、血管狭窄程度越重,血清Cat S水平就越高,呈正相关;血清Cat S及Cat S/Cys C增高和血清Cys C水平降低,与脑梗死的发生密切相关。

Objective To investigate the relationship between Cathepsin S/Cystatin C and intracranial/extracranial artery stenosis and plaque characterization of IS patients. Methods This study is a prospective case-control study and recruited patients diagnosed as atherosclerotic stroke in the neurological department of our hospital. The subjects were divided as stable plaque and unstable group respectively,and then each group was divided as mild stenosis,moderate stenosis and severe stenosis subgroups according to the stenosis intensity. Healthy patients were recruited as health control. All the patients were evaluated the neurological impairment by NIHSS scale. The bloods were collected and the ELISA and latex-enhanced immunoturbidimetric assay methods were used to detect the serum levels of Cat S and Cys C respectively. Results The levels of Cat S and ratio of Cat S/Cys C of the stroke group were significantly higher in stroke patients compared to the health controls,the mean of Cat S and ratios of Cat S/Cys C were （63.07±20.81）pg/ml / （50.49±10.54）pg/ml and （78.83±6.88）/（47.18±3.32） in patients and controls respectively. The levels of Cys C （0.80±0.11）mg/L of the stroke group were significantly lower than the health control （1.07±0.83）mg/L. The levels of Cat S and ratio of Cat S/Cys C of the unstable plaque group were significantly higher than the stable control group,the mean of Cats and ratios of Cat S / Cys C were （75.34±15.45）pg/ml / （60.12±18.53）pg/ml and （103.68±2.52）/（64.64±9.24） respectively. The levels of Cys C （0.73±0.62）mg/L of the unstable plaque group were significantly lower than the stable plaque group （0.93±0.53）mg/L. In subgroups （mild stenosis,moderate stenosis and severe stenosis） analysis,the levels of Cat S,Cys C and ratios of Cat S / Cys C has significant difference （P〈0.05）,with the tendency that the levels of Cat S and ratios of Cat S/Cys C were positively and Cys C were negatively correlated with the vascular stenosis severity. Conclusions The level of Cat S and ratios of Cat S/Cys C was positively and Cys C was negatively correlated with the vascular stenosis severtity and plaque activity. There were some correlation between Cathepsin S/Cystatin C and the patients with acute cerebra infarction.