C反应蛋白、肌钙蛋白对非心源性后循环梗死预后的评估价值

C-reactive protein and troponin in the prognosis of patients with acute non-cardiogenic posterior circulation cerebral infarction

目的:探讨C反应蛋白(CRP)、肌钙蛋白(cTn-T、cTn-I)对急性期非心源性后循环梗死(PCCI)患者预后的预测价值。方法:选取2018年5月至2019年6月期间就诊于新疆维吾尔自治区人民医院急诊科和神经内科确诊为急性非心源性脑梗死的连续住院患者,对患者发病12h内的血清CRP、cTn-T、cTn-I值进行分析。根据头颅MRI将PCCI筛选后纳入研究,依据随访时所得mRS90d评分将后循环组分别分为预后良好组(mRS评分0~2分)和预后不良组(mRS评分3~6分)。采集所有受试者病史、神经系统查体、实验室检查、辅助检查结果。通过对预后因素进行分析后得出CRP、肌钙蛋白评估急性非心源性后循环梗死的预测价值。结果:对相关实验室指标进行单因素分析后显示初始肌钙蛋白I(cTnI)(P=0.034)、肌钙蛋白T(cTnT)(P=0.013)、白介素6(IL-6)(P=0.000)、谷丙转氨酶(ALT)(P=0.001)、谷草转氨酶(GOT)(P=0.039)、D-二聚体(D-dimer)(P=0.000)、CRP(P=0.002)水平升高在两组患者之间差异有统计学意义(P<0.05)。将上述指标进行多元Logistic回归表明:CRP(OR=1.184,95%CI1.024-1.369,P=0.022)是非心源性栓塞后循环梗死90 d预后不良的独立危险因素,cTnI(OR=1.986,95%CI 0-4.293,P=0.452)、cTnT(OR=0,95%CI 0-3.918,P=0.639)不能评估非心源性PCCI 90d预后。结论:入院时血清CRP水平升高(>3.400mg/L)提示非心源性后循环梗死患者发病90d预后不良。但入院时肌钙蛋白(cTnI、cTnT)水平轻度升高虽不能作为非心源性PCCI预后的预测指标,仍需要我们引起重视。

Objective:To investigate the predictive value of C-reactive protein(CRP)and troponin(cTn-T,cTn-I)in the prognosis of patients with acute non-cardiogenic posterior circulation cerebral infarction(PCCI).Methods:Cases continuously diagnosed as acute non-cardiogenic PCCI from May 2018 to June 2019 in the department of Neurology and Critical Care Medicine of the People's Hospital of Xinjiang Uygur Autonomous Region were prospectively analyzed.CRP,cTn-T and cTn-I were col-lected within 12 hours of onset.The location of infarction was classified as PCCI according to MRI.According to modified Rankin Scale(mRS)scores of onset for 90 days,the cases with PCCI were di-vided into good prognosis group(mRS score 0 to 2)and poor prognosis group(mRS score 3 to 6).General state of health and results of laboratory examinations and other auxiliary examinations of all patients were recorded.Result:After single factor scoring of relevant laboratory indicators,the levels of initial cTnI(P=0.034),cTnT(P=0.013),IL-6(P=0.000),ALT(P=0.001),GOT(P=0.039),D-dimer(P=0.000),and CRP(P=0.002)increased,with statistical difference between the two groups(P<0.05).Multivariate Logistic regression showed that CRP(OR=1.184,95%CI 1.024-1.369,P=0.022)were found associated with poor prognosis of non-cardiogenic PCCI of onset for 90 days,while it could not be assessed by troponin CTnI(OR=1.986,95%CI 0-4.293,P=0.452)and CTnT(OR=0;95%CI 0-3.918,P=0.639).Conclusion:The increase of CRP(>3.400 mg/L)indicates that the prognosis of patients with acute none-Cardioembolic PCCI after onset for 90 days is poor.Troponin levels on admission may not be associated with poor prognosis of it.