同型半胱氨酸联合超敏C反应蛋白检测诊断脑梗死患者抑郁和认知功能异常的临床意义

Homocysteine combined with hypersensitivity C reaction protein in detection and diagnosis of depression and cognitive dysfunction of cerebral infarction patients

目的探讨同型半胱氨酸(Hcy)联合超敏C反应蛋白(Hs-CRP)检测对脑梗死患者抑郁和认知功能异常的诊断价值。方法选取2016年5月—2017年10月诊断为脑梗死的127例患者为研究对象,采用简易精神状态检查表(MMSE)和汉密尔顿抑郁量表(HAMD)判断认知功能异常和抑郁情绪,以此分为四组:A1组29例,仅出现抑郁情绪;A2组11例,仅出现认知功能异常;B组41例,出现抑郁情绪和认知功能异常;对照组46例,无认知功能异常和抑郁情绪的脑梗死患者,观察相关指标。结果 Hcy在B组浓度为(25.13±5.46)μmol/L,明显高于另外三组(P<0.05)。Hs-CRP在A1、A2组和B组中差异不大(P>0.05),但均高于对照组(P<0.05)。二者联合检测阳性率在四组间均无差异(P>0.05)。Hcy与HAMD、MMSE评分有很好相关性(P<0.05),而Hs-CRP相关性不强(P<0.05)。ROC曲线显示Hcy在提示脑梗死患者出现抑郁情绪或/和认知功能异常的AUC面积和特异性均高于Hs-CRP,但是敏感性却不如Hs-CRP,二者联合检测可以提高临床诊断价值。结论同型半胱氨酸联合超敏C反应蛋白检测诊断脑梗死患者抑郁和认知功能异常具有较大临床意义。

Objective To investigate the diagnostic value of homocysteine combined with hypersensitivity C reaction protein for the occurrence of depression and cognitive dysfunction in patients with cerebral infarction.Methods 127 patients diagnosed with cerebral infarction in our hospital from May,2016 to October,2017 were selected and divided into four groups by a simple mental state checklist(MMSE)and Hamilton Depression Scale(HAMD)to detect the cognitive dysfunction and depression:group A1 with 29 cases only with depression;group A2 with 11 cases only with cognitive dysfunction with group B with 41 cases with depression and cognitive dysfunction and control group,with 46 cases with neither cognitive dysfunction nor depression.The related indexes were observed.Results The concentration of Hcy in the group B was(25.13±5.46)μmol/L,which was significantly higher than those in the other three groups(P<0.05).The concentration of Hs-CRP in A1,A2 and B groups showed no significant difference(P>0.05),but all were higher than that of the control group(P<0.05).There was no difference in the positive rate of combined detection in the four groups(P>0.05).The score of Hcy showed a good correlation with HAMD and MMSE(P<0.05),but not the Hs-CRP(P<0.05).The ROC curve showed that AUC area and specificity of Hcy in detecting depression or/and cognitive dysfunction in patients with cerebral infarction were higher than those of Hs-CRP,but the sensitivity of Hcy was lower than Hs-CRP,so combined detection of both could improve the value of clinical diagnosis.Conclusion Homocysteine combined with hypersensitive C reaction protein has remarkable clinical value in the treatment of depression and cognitive dysfunction in patients with cerebral infarction.