脑梗死患者血清脂联素水平分析及其临床评价

Analysis and Clinical Evaluation of Serum Adiponectin Levelin Patients with Cerebral Infarction

目的探讨不同分子量脂联素(APN)在不同TOAST分型脑梗死病程中的变化及相关性,为临床防治脑梗死提供新的研究思路。方法选取182例脑梗死患者为脑梗死组,另选取115例非脑梗死患者为对照组,对比两组APN水平,观察不同分子量APN在不同TOAST分型病程分期中的变化,作相关性及二元logistic回归分析。结果总脂联素(tAPN)与高分子量脂联素(HMWAPN)密切相关(r=0.999),脑梗死组血清tAPN低于对照组(P<0.05),主要表现在脑梗死组HMWAPN水平的下降(P<0.05)。与对照组相比,大动脉粥样硬化组tAPN与HMWAPN水平显著降低(P<0.05),而小动脉闭塞组tAPN与HMWAPN水平在病程中呈现先下降后回升的趋势,在病程第4 d~第10 d时间段显著降低(P<0.05)。另外中分子量脂联素(MMWAPN)可能参与了大动脉粥样硬化型脑梗死急性期的应激反应,在病程72 h内MMWAPN呈现一过性增高(P<0.05)。HMWAPN是脑梗死发病的独立保护因素(P<0.05)。结论tAPN、HMWAPN与脑梗死密切相关,在不同TOAST分型、不同病程分期中表达水平有明显变化,具有重要临床参考价值。

Objective To explore the changes and correlation of adiponectin(APN)with different molecular weight in the course of different TOAST subtypes of cerebral infarction.Methods 182 patients with cerebral infarction were selected as cerebal infarction group,and 115 non-cerebral infarction patients as control group.The plasma APN levels were compared between the two groups.The changes of APN with different molecular weight in different TOAST subtypes and different stages of cerebral infarction were tested,and the correlation analysis and logistic regression analysis were performed.Results The level of total APN(tAPN)was closely related to the level of high molecular weight APN(HMW-APN)(r=0.999).The plasma tAPN level in cerebral infarction group was lower than that in control group(P<0.05),which was mainly manifested in the decrease of plasma HMW-APN in cerebral infarction group(P<0.05).Compared with the control group,among the cerebral infarction subgroups,the levels of tAPN and HMW-APN decreased significantly in subgroup with large artery atherosclerosis(P<0.05).However,the levels of tAPN and HMW-APN decreased first and then increased in subgroup with samll artery occlusion,and they decreased significantly between the 4th to 10th day of the disease course(P<0.05).In addition,moderate molecular weight APN(MMW-APN)might be involved in the stress response in the acute stage of large atherosclerotic cerebral infarction,which increased transiently within 72 hours(P<0.05).HMW-APN was an independent protective factor for cerebral infarction(P<0.05).Conclusion tAPN and HMW-APN are closely related to cerebral infarction.The levels of tAPN and HMW were various in different TOAST subtypes and different stages of cerebral infarction.