兴奋性氨基酸测定对急性脑梗死恶化进展预测的意义

The meaning of excition amino acids measurements for predicting the deterioration of patients with acute cerebral infarction

目的 研究急性脑梗死后谷氨酸 (Glu)、甘氨酸 (Gly)的变化规律及与梗死恶化进展的关系 ,寻找急性脑梗死恶化进展的预测指标。方法 采用高效液相色谱技术测定 1 1 2例发病 2 4 h内的急性脑梗死患者及 32例正常对照组血和脑脊液 (CSF)中 Glu、Gly浓度的变化。结果 脑梗死患者血和 CSF中 Glu、Gly浓度在发病 2 4 h内明显升高 ,与对照组比较有显著差异 (P<0 .0 0 1 )。其中急性脑梗死进展组血和 CSF中 Glu浓度(1 53.0 5± 35.80 ,78.80± 2 6.95)较稳定组血和 CSF中 Glu浓度 (1 0 7.44± 2 3.82 ,2 7.75± 9.89)有明显差异 (P<0 .0 0 1 )。血中 Glu浓度超过1 30 μmol/ L和 CSF浓度超过 50 μmol/ L与早期神经功能缺损症状进展有独立的显著联系 (2 5.7,41 .5) ,特别是 CSF中 Glu浓度超过 50 μmol/ L,其预测的灵敏性、特异性、准确性分别为 95.3%、99.7%、97.5%。结论 急性脑梗死早期神经功能缺损的进展与血和 CSF中 Glu浓度增高有关 ,血中 Glu浓度超过 1 30 μmol/ L和 CSF浓度超过 50 μmol/ L是发病 48h内病情恶化进展的重要预测指标。特别是 CSF中 Glu浓度超过 50 μmol/ L其预测价值更大。

Objective To seek for predictive markers of deterioration of the patients with acute cerebral infarction by studying the levels of Glu and Gly in their blood and CSF.Methods High performance liquid chromatography (HPLC) was used to detect the levels of Glu and Gly in blood and CSF. The samples were taken from 112 cases of patients with acute cerebral infarction within 24 hours after the ictus. At the same time, 32 healthy persons were detected as the normal controls. Results Levels of the Glu and Gly in both blood and CSF of patients obviously increased within 24 hours after the ictus, and were significantly higher than those in the control group (P<0.001). Furthermore, in the acute progressive cerebral infarction group, the mean level of Glu in the blood was 153.05±35.80 μmol/L, and that in the CSF is 78.80±26.95 μmol/L. Likewise, in the stable cerebral infarction group, the mean level of Glu in blood was 107.44±23.82 μmol/L, and in the CSF is 27.75±9.89 μmol/L. The differences of the counterpart levels between two groups were significant (P<0.001). It was the levels of Glu in blood over 130 μmol/L or those in the CSF over 50μmol/L that independently correlated to the defects of nurological function (25.7 and 41.5). When the levels of Glu in the CSF were higher than 50 μmol/L, they predicted the deterioration of the patients with the 95.3% sensitivity, 99.7% specificity, and 97.5% accuracy respectively.Conclusions Progressive neurological functional defects of patients with acute cerebral infarction in their early stage relate to the increased levels of Glu in CSF. When the levels of Glu in plasm are higher than 130 μmol/L or, particularly, the levels of Glu in CSF higher than 50 μmol/L, they would be looked as useful markers to predict the deterioration of the patients within 48 hours after the ictus.