急性脑梗死患者血清VEGF,SAA和Lp-PLA2联合检测的临床研究

Diagnostic Value of Combined Detection of VEGF,SAA and Lp-PLA2 for Acute Cerebral Infarction

目的探讨血清血管内皮细胞生长因子(VEGF)、淀粉样蛋白A(SAA)和脂蛋白相关磷脂酶A2(Lp-PLA2)水平与急性脑梗死(ACI)的关系,为ACI的诊治提供依据。方法选择2017年8月~12月间西京医院收治的急性脑梗死患者76例作为ACI组,另选择同期在该院进行体检的健康者32例作为对照(NC)组。采用散射比浊法进行SAA水平的检测,采用双抗体夹心法(ELISA)进行VEGF和Lp-PLA2的测定。比较各组间检测指标的差异,采用尤登指数评价各指标及联合检测的诊断价值。结果 ACI组SAA,Lp-PLA2和VEGF含量均显著高于NC组(t=3.501,4.943和5.724,均P<0.01)。ACI组VEGF与Lp-PLA2,SAA呈正相关(r=0.417,0.434,均P<0.01)。血清VEGF,SAA和Lp-PLA2辅助诊断ACI的最佳诊断临界点分别为161.93pg/ml,3.81mg/L和185.11ng/ml,灵敏度分别为93.55%,65.91%和43.10%,特异度分别为60.00%,93.75%和89.12%;联合检测以SAA和VEGF联合为最优,优于单项检测及三项联合检测,SAA与VEGF联合检测灵敏度为90.63%,特异度为97.73%,尤登指数0.88。结论 VEGF,SAA和Lp-PLA2在ACI患者血清中显著升高,其表达对于ACI的诊断具有重要价值。VEGF与SAA,Lp-PLA2呈正相关,可能具有协同作用,参与脑梗死的病理过程。SAA与VEGF联合检测对脑梗死的诊断具有较高的临床价值。

Objective To discuss the relativity between the levels of vascular endothelial growth factor（VEGF）,serum amyloid A（SAA）,lipoprotein-associated phospholipase A2（Lp-PLA2）and acute cerebral infarction（ACI）,for providing the basis for the diagnosis of ACI.Methods 76 patients with ACI were selected as ACI group in Xijing Hospital from August2017 to December 2017.In addition,32 healthy subjects who underwent physical examination in the same period in this hospital were selected as negative control（NC）group.SAA levels were detected by nephelometry.VEGF and Lp-PLA2 were measured by enzyme-linked immunosorbent assay（ELISA）.Compared the difference of detection indexes between the two groups,and evaluated the diagnostic value of each index and joint jinspection with the youden index.Results In group ACI,the contents of SAA,Lp-PLA2 and VEGF in 76 patients with ACI were significantly higher than those in NC group（t=3.501,4.943,5.724,all P〈0.01）.In group ACI,VEGF was positively correlated with SAA and Lp-PLA2（r=0.434,0.417,all P〈0.01）.The excellent diagnostics of VEGF,SAA and Lp-PLA2 for auxiliary diagnosing ACI were 161.93 pg/ml,3.81 mg/L and 185.11 ng/ml,respectively.The sensitivities were 93.55%,65.91% and 43.10%,respectively.The specificities were 60.00%,93.75% and 89.12%,respectively.Combined detection with SAA and VEGF was superiodrior to single event detection and other joint detection.The sensitivity of combined detection with SAA and VEGF was 90.63%.The specificity of combined detection with SAA and VEGF was 97.73% and Youden Index（YI）was 0.88.ConclusionVEGF,SAA and Lp-PLA2 increased in serum of patients with acute cerebral infarction,the expression has important value for the diagnosis of acute cerebral infarction.VEGF was positively related to SAA and Lp-PLA2,and could have synergistic effects.VEGF may be involved in the pathological process of cerebral infarction.The combined detection of SAA and VEGF has a high clinical value in the diagnosis of cerebral infarction.