血清LP(a)、LDL-C、Hcy和Cys C与急性脑梗死的相关性及诊断价值的研究

Study on the correlation of serum levels of LP(a),LDL-C,Hcy and Cys C with acute cerebral infarction and their diagnostic value

目的:探讨急性脑梗死(ACI)病人血清脂蛋白a[LP(a)]、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(Hcy)、胱抑素C(Cys C)水平与ACI的相关性及其在ACI诊断中的价值。方法:选取ACI病人300例作为病例组,采用美国国立卫生研究院卒中量表(NHISS)进行神经功能评分,并选择同期体检者70名作为对照组。比较2组血清葡萄糖(GLU)、胆固醇(CHOL)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)、Lp(a)、Hcy、LDL-C、Cys C水平。根据NHISS评分将ACI病人分为轻度组(n=173)、中度组(n=89)和重度组(n=38),比较各组血清LP(a)、LDL-C、Hcy、Cys C水平。通过多元logistic回归构建多因素模型,并对模型绘制ROC曲线评价LP(a)、LDL-C、Hcy、Cys C单独和联合对ACI的诊断价值。结果:病例组血清GLU、CHOL、HDL-C、Lp(a)、Hcy、LD-C L、Cys C水平均高于对照组(P<0.05~P<0.01),2组TG水平差异无统计学意义(P>0.05)。ACI轻度组、中度组、重度组血清LDL-C、Hcy水平均逐渐升高(P<0.05);3组血清LP(a)、Cys C水平差异均无统计学意义(P>0.05)。ROC分析显示,Hcy单独诊断ACI的准确性较高(ROC曲线下面积、灵敏度、特异性、约登指数分别为0.799、81.00%、88.53%、69.53%),血清LP(a)、LDL-C、Hcy及Cys C联合检测诊断ACI的准确性最高(ROC曲线下面积、灵敏度、特异性、约登指数分别为0.841、97.14%、90.63%、87.77%)。结论:血清LP(a)、LDL-C、Hcy及Cys C的水平与ACI的发生相关,LDL-C、Hcy与脑梗死的严重程度相关。联合LP(a)、LDL-C、Hcy及Cys C对诊断ACI具有更高的敏感度和特异性,其可能成为早期预测ACI发生的生物学指标。

Objective:To investigate the correlation of serum levels of lipoprotein a[LP(a)],low-density lipoprotein cholesterol(LDL-C),homocysteine(Hcy)and cystatin C(Cys C)with acute cerebral infarction(ACI),and their diagnostic value.Methods:The neurological function scoring in 300 ACI patients(case group)were investigated using NHISS scale,and 70 medical examinees were set as the control group during the same period.The serum levels of glucose(GLU),cholesterol(CHOL),high-density lipoprotein cholesterol(HDL-C),triacylagly cerol(TG),LP(a),LDL-C,Hcy and Cys C were compared between two groups.According to NHISS score,the ACI patients were divided into the mild group(n=173),moderate group(n=89)and severe group(n=38),and the serum levels of LP(a),LDL-C,Hcy and Cys C among three groups were compared.The multi-factor model was established using multivariate logistic regression,and the ROC curve was drawn to evaluate the diagnostic value of alone and combination of LP(a),LDL-C,Hcy and Cys C for ACI.Results:The serum levels of GLU,CHOL,HDL-C,LP(a),LDL,Hcy and Cys C in case group were higher than those in control group(P<0.05 to P<0.01),and the difference of the level of TG between two groups was not statistically significant(P>0.05).The serum levels of LDL-C and Hcy in ACI mild group,moderate group and severe group gradually increased(P<0.05);and the differences of the levels of LDL-C and Hcy among three groups was not statistically significant(P>0.05).The results of ROC analysis showed that the Hcy alone in the diagnosis of ACI had high accuracy(the area under ROC curve,sensitivity,specificity and Youden index were 0.799,81.00%,88.53%and 69.53%,respectively).The accuracy of combination of serum LP(a),LDL-C,Hcy and Cys C in the diagnosis of ACI was the highest(the area under ROC curve,sensitivity,specificity,Youden index were 0.841,97.14%;90.63%,87.77%and 0.80,respectively).Conclusions:The serum levels of LP(a),LDL-C,Hcy and Cys C are related to the occurrence and severity of ACI,and the LDL-C and Hcy are associated with the severity of ACI.The combined detection of LDL-C,Hcy and Cys C has a higher sensitivity and specificity for the diagnosis of ACI,which may become an early predictor biological indicating of ACI occurrence.