急性缺血性脑卒中患者血清CRP、TNF-α、IL-1β、HIF-1α、NSE、SAA对神经功能损伤的诊断价值

The predicted significances of serum CRP,TNF-α,IL-1β,HIF-1α,NSE and SAA for patients with acute ischemic stroke

目的探讨急性缺血性脑卒中患者卒中量表(NIHSS)严重程度相关的优势影响因子及临床诊断价值。方法选取神经内科就诊、经临床检查确诊为急性缺血性脑卒中住院患者112例(观察组)作为研究对象。根据NIHSS评分将观察组分为轻度、中度、重度神经功能缺损组。选择同一时期的健康人群35例作为对照组。通过酶联免疫吸附法对所有入组者的血清进行检测,观察血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、缺氧诱导因子-1α(HIF-1α)、神经元特异性烯醇化酶(NSE)、血清淀粉样蛋白A(SAA)水平变化。结果 (1)观察组血清CRP、TNF-α、IL-1β、HIF-1α、NSE、SAA水平均明显高于对照组,比较差异有统计学意义(P<0.05)。(2)不同神经功能缺损程度的急性缺血性脑卒中患者血清CRP、TNF-α、IL-1β、HIF-1α、NSE、SAA比较差异均有统计学意义(P<0.05);神经功能缺损越重,各指标水平越高,呈正相关。(3)经Pearson相关性分析显示,NIHSS分值与CRP、TNF-α、IL-1β、HIF-1α、NSE、SAA均呈相关,其中NSE、HIF-1α、IL-1β最为密切。(4)ROC分析显示,CRP、TNF-α、IL-1β、HIF-1α、NSE、SAA的AUC分别为0.779、0.699、0.801、0.869、0.888、0.731;NSE、HIF-1α、IL-1β诊断价值最大。结论 CRP、TNF-α、IL-1β、HIF-1α、NSE、SAA对基于NIHSS评分的急性缺血性卒中患者有一定诊断价值,尤其是NSE、HIF-1α、IL-1β三者诊断价值高,为优势检测指标。有助于提高急性缺血性脑卒中患者的临床早期诊断。

Objective To investigate the dominant influence factors of severity levels of NIHSS and the clinical diagnostic value in patients with acute ischemic stroke. Methods 112 patients with acute ischemic stroke were selected as the study subjects(observation group). The observation group was divided into mild, moderate and severe neurological impairment groups according to stroke scale(NIHSS) score. 35 healthy subjects in the same period were selected as the control group. Serum levels of CRP, TNF-α, IL-1β, HIF-1α, NSE and SAA were measured by ELISA. Results Serum levels of CRP, TNF-α, IL-1β, HIF-1α, NSE and SAA in the observation group were significantly higher than those in the control group(P<0.05). The differences in serum CRP, TNF-α, IL-1β, HIF-1α, NSE and SAA among patients with acute ischemic stroke with different degrees of neurological impairment were statistically significant(P<0.05). The higher the defect of nerve function, the higher the level of each index. Pearson correlation analysis showed that NIHSS scores were positively correlated with the levels of serum CRP, TNF-α, IL-1β, HIF-1α, NSE and SAA;among which NSE, HIF-1α and IL-1β were the most closely correlated. ROC analysis showed that the AUCs of CRP, TNF-α, IL-1β, HIF-1α, NSE and SAA were 0.779, 0.699, 0.801, 0.869, 0.888 and 0.731, respectively. It is suggested that NSE, HIF-1α and IL-1β had the greatest diagnostic value. Conclusion CRP, TNF-α, IL-1β, HIF-1α, NSE and SAA have definite diagnostic value for patients with acute ischemic stroke based on NIHSS score;especially NSE, HIF-1α and IL-1β are the dominant detection indicators. They are helpful to improve the early clinical diagnosis, prevention and treatment of acute ischemic stroke patients.