血清淀粉样蛋白A和脂蛋白磷脂酶A2联合同型半胱氨酸检测在急性缺血性脑卒中的诊断价值

The value of serum amyloid A and lipoprotein phospholipase A2combined with homocysteine in the diagnosis of acute ischemic stroke

目的探讨血清淀粉样蛋白A(SAA)、脂蛋白磷脂酶A2(Lp-PLA2)和同型半胱氨酸(Hcy)联合检测在急性缺血性脑卒中的诊断价值。方法选取168例急性缺血性脑卒中患者为实验组,根据MRI或CT显示梗死灶最大截面长短径分为小面积组(n=56)、中面积组(n=42)、大面积组(n=70);根据美国国立卫生院卒中量表(NIHSS)评分将实验组患者分为轻度损伤组(<4分,n=62)、中度损伤组(4~15分,n=35)和重度损伤组(>15分,n=71)。选择同时期体检健康者50例为对照组,采用胶乳免疫比浊法测定SAA,酶联免疫吸附试验(ELISA)法测定Lp-PLA2,循环酶法测定Hcy,对三者单独及联合检测预测急性缺血性脑卒中的价值进行比较,另外分析三者浓度与脑梗死面积和神经功能损伤程度的关系。结果实验组SAA、Lp-PLA2和Hcy明显高于对照组,差异均具有统计学意义(P<0.05),各指标浓度呈正相关(r分别为0.545、0.339、0.297,P<0.01)。三者联合检测优于单独检测,并且三者浓度随着脑梗死面积的增加和神经功能损伤程度的升高而升高,差异均具有统计学意义(P<0.05)。结论急性缺血性脑卒中患者SAA、Lp-PLA2和Hcy浓度明显升高,三者联合检测对临床预测、诊断及判断脑梗死严重程度有重要意义。

Objective To explore the value of the combined detection of serum amyloid protein A（SAA）,plasma lipoprotein phospholipase A2（Lp-PLA2）and homocysteine（Hcy）in the diagnosis of acute ischemic stroke.Methods 168 cases of acute ischemic stroke were selected as experimental group.According to the maximum section of the infarct size of MRI or CT,the patients were divided into small area group（n=56）,medium area group（n=42）and large area group（n=70）.According to the National Institutes of Health Stroke Scale（NIHSS）score,the patients in the experimental group were divided into mild injury group（〈4 scores,n=62）,moderate injury group（4-15 scores,n=35）and severe injury group（〉15 scores,n=71）.50 healthy subjects at the same time were selected as the control group.SAA was measured by latex immuno turbidimetry,Lp-PLA2 was measured by ELISA,and Hcy was measured by cyclic enzyme method.The value of the three individual and combined detection of acute ischemic stroke was compared.In addition,the relationship between the three levels and the infarct size of the cerebral infarction and the degree of nerve function injury was analyzed.Results The SAA,Lp-PLA2 and Hcy levels in the experimental group were significantly higher than those in the control group,and the differences were statistically significant（P〈0.05）,and the concentration of each index was positively correlated（r=0.545,0.339,0.297,P〈0.01）.The combined detection of the three was superior to the single test,and the concentration of the three was increased with the increase of the area of cerebral infarction and the increase of the degree of nerve function injury,and the difference was statistically significant（P〈0.05）.Conclusion The concentration of SAA,Lp-PLA2 and Hcy in the patients with acute ischemic stroke is obviously increased.The combined detection of the three is of great significance to the clinical prediction,diagnosis and judgement of the severity of cerebral infarction.