急性脑梗死患者急性期血清骨桥蛋白和氧化应激指标水平与患者神经损伤和预后的相关性探讨

Correlation between serum osteopontin and oxidative stress indicators and nerve injury and prognosis in patients with acute cerebral infarction.

目的探讨急性脑梗死患者急性期血清骨桥蛋白(OPN)水平和氧化应激水平与患者神经损伤和预后的相关性。方法采用回顾性研究方法,选取2018年4月至2019年5月秦皇岛市第一医院全科医疗科收治的发病时间在48 h内的急性脑梗死患者55例作为观察组,选择同期健康体检的50例受检者为对照组,对比两组患者的血清OPN、超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)水平以及治疗7 d的美国国立卫生院卒中量表(NIHSS)、治疗90 d的改良mRS量表(mRS)评分。分别以NIHSS≥7分与mRS<2分为预后标准进行分组,对比血清指标并探讨各项指标的相关关系。结果观察组患者的血清OPN(8.31±2.65 ng/ml vs.5.04±2.17 ng/ml)、MDA水平(14.62±4.31 nmol/ml vs.2.22±0.48 nmol/ml)均明显高于对照组(P<0.05),SOD(167.25±17.33 U/ml vs.376.67±21.58 U/ml)与GSH-Px(43.29±5.85 U/L vs.124.18±13.17 U/L)水平明显低于对照组(P<0.05)。NIHSS≥7分以上患者的血清OPN(10.31±3.41 ng/ml vs.5.32±2.08 ng/ml)、MDA(17.84±4.39 vs.10.08±3.79 nmol/ml)水平均明显高于NIHSS评分<7分的患者(P<0.05),SOD(154.69±14.26 nmol/ml vs.186.23±20.36 U/ml)与GSH-Px(38.78±5.89 vs.52.34±6.27 U/L)水平明显低于NIHSS评分<7分的患者(P<0.05)。mRS评分≥2分患者的血清OPN(10.33±3.11 ng/ml vs.7.20±2.27 ng/ml)、MDA(20.31±5.27 nmol/ml vs.12.12±4.22 nmol/ml)水平均明显高于mRS评分<2分的患者(P<0.05),SOD(147.63±17.22 U/ml vs.179.12±21.23 U/ml)与GSH-Px(34.96±5.18 U/L vs.48.31±6.35 U/L)水平明显低于mRS评分<2分的患者(P<0.05)。OPN、MDA水平与NHISS、mRS评分存在明显的正相关关系(r=0.706、0.734、0.561、0.604,P<0.05),SOD、GSH-Px水平与NHISS、mRS评分存在明显的负相关关系(r=-0.742、-0.822、-0.597、-0.631,P<0.05)。结论急性脑梗死患者急性期的血清OPN以及氧化应激指标都会明显改变,上述指标对神经功能以及预后预测有较高的作用,可以作为神经功能与预后判定的关键性指标。

Objective To investigate the correlation between acute osteopontin(OPN)level and oxidative stress level and nerve injury and prognosis in patients with acute cerebral infarction.Methods 55 patients with acute cerebral infarction with an onset time within 48 hours were retrospectively selected from the general medical department of Qinhuangdao First Hospital from April 2018 to May 2019 as the observation group.A total of 50 patients underwent physical examination during the same period were selected as the control group.The serum levels of OPN,superoxide dismutase(SOD),malondialdehyde(MDA),glutathione peroxidase(GSH-Px),National Institutes of Health Stroke Scale(NIHSS)after 7 days treatment and the modified mRS scale(mRS)for 90 days treatment were compared between the two groups of patients.Patients were grouped according to the prognostic criteria of NIHSS≥7 points or mRS<2 points,respectively,and serum indicators and the correlation were analyzed.Results The serum OPN(8.31±2.65 vs.5.04±2.17 ng/ml)and MDA level(14.62±4.31 nmol/ml vs.2.22±0.48 nmol/ml)in the observation group were significantly higher than those in the control group(P<0.05),and SOD(167.25±17.33 U/ml vs.376.67±21.58 U/ml)and GSH-Px(43.29±5.85 U/L vs.124.18±13.17 U/L)were significantly lower than those in the control group(P<0.05).The levels of serum OPN(10.31±3.41 ng/ml vs.5.32±2.08 ng/ml)and MDA(17.84±4.39 nmol/ml vs.10.08±3.79 nmol/ml)in patients with NIHSS≥7 points were significantly higher than those in patients with NIHSS scores<7 points(P<0.05),SOD(154.69±14.26 U/ml vs.186.23±20.36 U/ml)and GSH-Px(38.78±5.89 U/L vs.52.34±6.27 U/L)were significantly lower than those with a NIHSS score of<7(P<0.05).Serum OPN(10.33±3.11 ng/ml vs.7.20±2.27 ng/ml)and MDA(20.31±5.27 nmol/ml vs.12.12±4.22 nmol/ml)in patients with mRS score≥2 were significantly higher than those in patients with mRS score<2(P<0.05),SOD(147.63±17.22 U/ml vs.179.12±21.23 U/ml)and GSH-Px(34.96±5.18 U/L vs.48.31±6.35 U/L)levels were significantly lower than those with mRS scores<2 points(P<0.05).There was a significant positive correlation between OPN and MDA levels and NHISS and mRS scores(r=0.706,0.734,0.561,0.604,P<0.05),and there was a significant negative correlation between SOD and GSH-Px levels and NHISS and mRS scores(r=-0.742,-0.822,-0.597,-0.631,P<0.05).Conclusion Serum OPN and oxidative stress in acute cerebral infarction patients can be significantly changed,which plays a higher role in predicting neurological function and prognosis,and can be used as a key indicator of neurological function and prognosis.