急性脑梗死血清hs-CRP脂蛋白(a)及D-二聚体水平与颅内动脉狭窄的相关性研究

Study on the relationship between the levels of serum hs-CRP,lipoprotein(a),D-dimer and intracranial artery stenosis in patients with acute cerebral infarction

目的通过检测急性脑梗死患者血清脂蛋白(a)Lp(a)、超敏C反应蛋白(hs-CRP)及D-二聚体水平,观察其与颅内动脉狭窄相关性。方法对入院后确诊的急性脑梗死患者进行颈动脉彩超、头颅MRA筛查,对存在颅内动脉狭窄的患者行全脑血管造影(DSA)检查,同时采用免疫散色比浊法和免疫透射比浊法检测其血清hs-CRP、Lp(a)和D-二聚体水平。DSA显示脑动脉内径正常或狭窄<50%为非狭窄组,颅内动脉颈内动脉(ICA)、大脑前动脉(ACA)、大脑中动脉(MCA)、基底动脉(BA)、椎动脉颅内段(VA)中至少有1支内径狭窄≥50%的为狭窄组。结果狭窄组入组病例150例,非狭窄组入组病例148例,狭窄组Lp(a)、hs-CRP、D-二聚体水平均较非狭窄组显著升高,差异有统计学意义(P<0.05);其中单支病变亚组和多支病变亚组比较,多支病变亚组患者Lp(a)、hs-CRP、D-二聚体水平较单支病变亚组明显升高(P<0.05)。结论伴颅内动脉明显狭窄的急性脑梗死患者血清Lp(a)、hs-CRP、D-二聚体水平较无颅内动脉狭窄者显著升高,多支颅内动脉狭窄者升高尤为明显,炎症机制可能参与了颅内动脉狭窄的发生发展过程。

Objective To detect the levels of serum hypersensitive C-reactive protein(hs-CRP),lipoprotein(a)(Lp(a))and D-dimer(DD)in acute cerebral infarction patients and to observe its relevance with intracranial artery stenosis in those patients.Methods Patients who meets the diagnostic criteria of acute cerebral infarction was selected to receive examinations of carotid artery Doppler ultrasonography,head MRI and MRA.Cerebral angiography(DSA)will be achieved if intracerebral artery stenosis was found.Meanwhile,the levels of serum hs-CRP,Lp(a)and DD were detected by means of immune scatter turbidimetry and immune transmission turbidity.Cases with normal diameter or stenosis<50%of intracerebral artery according to DSA were selected as the non-stenosis group.Cases with stenosis more than 50%in at least one intracerebral artery(ICA,ACA,MCA,BA or VA(Intracranial segment))were accepted as the stenosis group.Results 150 cases were included in the stenosis group while 148 cases in the non-stenosis group.Levels of Lp(a),hs-CRP,and DD were significantly increased in stenosis group than in the non-stenosis group(P<0.05).The levels of Lp(a),hs-CRP and DD in patients with multiple vessel stenosis subgroup were significantly higher than those in single vessel stenosis subgroup(P<0.05).Conclusion The serum levels of Lp(a),hs-CRP and DD in acute cerebral infarction patients with intracranial artery stenosis were much higher than those without intracranial artery stenosis,especially in patients with multiple intracranial artery stenosis.Inflammation may be involved in the occurrence and development of intracranial artery stenosis and cerebralvascular events.