血清脂蛋白相关磷脂酶A2、同型半胱氨酸、胱抑素C水平与急性脑梗死及其神经功能缺损程度、短期预后的关系研究

Relations of Serum Levels of Lp-PLA2,Hcy and Cys C to Acute Cerebral Infarction,Degree of Neurological Deficit and Recent Prognosis

背景 新型炎性因子促动脉粥样硬化斑块形成作用的证实使其与急性脑梗死(ACI)的关系研究成为热点。目的 探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)、同型半胱氨酸(Hcy)及胱抑素C(CysC)水平与ACI及其神经功能缺损程度、短期预后的关系。方法 选取2013年10月—2017年10月沧州市人民医院神经内科收治的ACI患者267例作为病例组,另选取同期体检健康者180例作为对照组。根据入院时美国国立卫生研究院卒中量表(NIHSS)评分将ACI患者分为轻度神经功能缺损组(轻度组,NIHSS评分<4分)99例、中度神经功能缺损组(中度组,NIHSS评分为4~15分)156例、重度神经功能缺损组(重度组,NIHSS评分>15分)12例;根据治疗3周改良Rankin量表(mRS)评分将ACI患者分为预后良好组(mRS评分≤2分,n=216)、预后不良组(mRS评分>2分,n=51)。比较对照组与病例组受试者一般资料,对照组与病例组受试者及不同神经功能缺损程度、短期预后患者血清Lp-PLA2、Hcy、CysC水平;绘制受试者工作特征(ROC)曲线以评价血清Lp-PLA2、Hcy、CysC水平对ACI及其短期预后的预测价值。结果 (1)对照组与病例组受试者性别、年龄、吸烟史、饮酒史及高血压、冠心病、糖尿病发生率比较,差异无统计学意义(P>0.05);病例组患者心房颤动发生率及血清Lp-PLA2、Hcy、CysC水平高于对照组(P<0.05)。(2)中度组和重度组患者血清Lp-PLA2、Hcy水平高于轻度组,重度组患者血清Lp-PLA2、Hcy水平高于中度组(P<0.05);轻度组患者血清CysC水平高于中度组但低于重度组(P<0.05)。(3)预后不良组患者血清Lp-PLA2、Hcy、CysC水平高于预后良好组(P<0.05)。(4)ROC曲线显示,血清Lp-PLA2水平预测ACI的曲线下面积(AUC)为0.963〔95%CI(0.948,0.979)〕,血清Hcy水平为0.985〔95%CI(0.977,0.993)〕,血清CysC水平为0.779〔95%CI(0.733,0.825)〕。血清Lp-PLA2水平预测ACI患者短期预后的AUC为0.821〔95%CI(0.751,0.892)〕,血清Hcy水平为0.719〔95%CI(0.637,0.800)〕,血清CysC水平为0.664〔95%CI(0.578,0.751)〕。结论 血清Lp-PLA2、Hcy水平与ACI及其神经功能缺损程度、短期预后有关,且二者对ACI及其短期预后的预测价值较高;血清CysC水平与ACI患者神经功能缺损程度无明显相关,其对ACI及其短期预后的预测价值一般。

Background Relationship between novel inflammatory cytokines and acute cerebral infarction(ACI) became one of research hotspots due to its promoting formation of atherosclerotic plaques. Objective To investigate the relations of serum levels of Lp-PLA2,Hcy and Cys C to ACI,degree of neurological deficit and recent prognosis. Methods From October 2013 to October 2017,a total of 267 patients with ACI were selected as case group in the Department of Neurology, the People's Hospital of Cangzhou,meanwhile a total of 180 healthy volunteers admitted to this hospital for physical examination were selected as control group,thereinto patients in case group were divided into A1 group(with mild neurological deficit that is NIHSS score less than 4,n=99),A2 group(with moderate neurological deficit that is NIHSS score from 4 to 15,n=156) and A3 group(with severe neurological deficit that is NIHSS score over 15,n=12)according to NIHSS score at admission, into B1 group(with good prognosis that is mRS score equal or less than 2,n=216)and B2 group(with poor prognosis that is mRS score over 2,n=51)according to modified Rankin scale(mRS)score 3 weeks after treatment. General information, serum levels of Lp-PLA2,Hcy and Cys C were compared between control group and case group,meanwhile serum levels of Lp- PLA2,Hcy and Cys C were compared in ACI patients with different degree of neurological deficit and prognosis;ROC curve was drawn to evaluate the predictive value of serum levels of Lp-PLA2,Hcy and Cys C on ACI and recent prognosis. Results (1)No statistically significant difference of gender,age,history of smoking or drinking,incidence of hypertension,coronary disease or diabetes was found between control group and case group(P>0.05);incidence of atrial fibrillation,serum levels of Lp-PLA2,Hcy and Cys C in case group were statistically significantly higher than those in control group(P<0.05).(2) Serum levels of Lp-PLA2 and Hcy in A2 group and A3 group were statistically significantly higher than those in A1 group, meanwhile serum levels of Lp-PLA2 and Hcy in A3 group were statistically significantly higher than those in A2 group(P<0.05);serum Cys C level in A1 group was statistically significantly higher than that in A2 group but lower than that in A3 group(P<0.05).(3)Serum levels of Lp-PLA2,Hcy and Cys C in B2 group were statistically significantly higher than those in B1 group(P<0.05).(4)ROC curve showed that,AUC of serum Lp-PLA2 level in predicting ACI was 0.963〔95%CI(0.948,0.979)〕,that of serum Hcy level was 0.985〔95%CI(0.977,0.993)〕,and that of serum Cys C level was 0.779〔95%CI(0.733,0.825)〕;AUC of serum Lp-PLA2 level in predicting recent prognosis in patients with ACI was 0.821〔95%CI(0.751,0.892)〕, that of serum Hcy level was 0.719〔95%CI(0.637,0.800)〕,and that of serum Cys C level was 0.664〔95%CI(0.578, 0.751)〕. Conclusion Serum levels of Lp-PLA2 and Hcy are significantly correlated with ACI degree of neurological deficit and recent prognosis,and predictive value of the above two is relatively high in predicting ACI and recent prognosis;serum Cys C level is not significantly correlated with degree of neurological deficit in patients with ACI,and its predictive value is average in predicting ACI and recent prognosis.