血清同型半胱氨酸、C反应蛋白、低密度脂蛋白水平与脑梗死TOAST各亚型、预后的关系

The Relationship Between Serum Homocysteine,C-reactive Protein,Low-density Lipoprotein Levels and TOAST Subtypes,Prognosis of Cerebral Infarction

目的分析血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)、低密度脂蛋白(LDL)水平与脑梗死治疗Org 10172试验(TOAST)各亚型、预后的关系。方法选取2016年4月至2019年3月我院收治的脑梗死患者96例(记为观察组)及同期入院体检的健康志愿者40例(记为对照组),对比两组入院时血清Hcy、CRP、LDL水平、美国国立卫生研究院量表评分(NIHSS),比较不同TOAST亚型、不同预后脑梗死患者的Hcy、CRP、LDL水平、NIHSS评分,分析Hcy、CRP、LDL水平与其TOAST分型、预后的关系。结果观察组入院时血清Hcy、CRP、LDL水平高于对照组(P<0.01);不同TOAST分型的脑梗死患者Hcy、CRP、LDL水平、NIHSS评分差异有统计学意义(P<0.01),且LAA组血清Hcy、CRP、LDL水平、NIHSS评分高于其他TOAST各亚型,SUE型患者Hcy、CRP水平最低(P<0.05);预后良好组入院时的Hcy、CRP、LDL水平、NIHSS评分低于预后不良组(P<0.05);Pearson相关分析显示,脑梗死患者入院时血清Hcy、CRP、LDL水平与其NIHSS评分呈正相关(P<0.05);血清Hcy、CRP、LDL预测脑梗死患者预后的曲线下面积分别为0.745、0.735、0.694。结论血清Hcy、CRP、LDL与脑梗死TOAST分型有密切关系,其中LAA型患者血清Hcy、CRP、LDL升高最明显,Hcy、CRP、LDL能较好预测预后,值得在临床推广应用。

Objective To analyze relationship between serum homocysteine(Hcy),C-reactive protein(CRP),low-density lipoprotein(LDL)levels and subtypes of trial of org 10172 in acute stroke treatment(TOAST),as well as the prognosis of cerebral infarction.Methods 96 patients with cerebral infarction who were admitted to the hospital from April,2016 to March,2019(the observation group)and 40 healthy volunteers who underwent physical examination in the hospital during the same period(the control group)were enrolled for the study.The levels of serum Hcy,CRP and LDL,score of National Institutes of Health Stroke Scale(NIHSS)at admission were compared between the two groups.The levels of Hcy,CRP and LDL,and NIHSS score were compared among cerebral infarction patients with different TOAST subtypes and prognosis.The relationships between Hcy,CRP,LDL levels and TOAST subtypes,as well as prognosis were analyzed.Results At admission,levels of serum Hcy,CRP and LDL in the observation group were significantly higher than those in the control group(P<0.01).There were significant differences in levels of Hcy,CRP and LDL,or NIHSS score among cerebral infarction patients with different TOAST subtypes(P<0.01).The levels of serum Hcy,CRP and LDL,and NIHSS score in LAA group were higher than those in other TOAST subtypes.The levels of Hcy and CRP were the lowest in SUE type patients(P<0.05).At admission,levels of Hcy,CRP and LDL,and NIHSS score in good prognosis group were lower than those in poor prognosis group(P<0.05).Pearson correlation analysis showed that serum Hcy,CRP and LDL levels were positively correlated with NIHSS scores in patients with cerebral infarction at admission(P<0.05).The areas under the curve of serum Hcy,CRP,LDL for predicting prognosis of patients with cerebral infarction were 0.745,0.735,and 0.694,respectively.Conclusion Serum Hcy,CRP and LDL are closely related to TOAST subtypes of cerebral infarction.The increases of serum Hcy,CRP and LDL are the strongest in LAA type patients.Hcy,CRP and LDL can predict prognosis well.