缺血性脑卒中患者血清谷胱甘肽还原酶活性及同型半胱氨酸水平的变化及临床意义

Glutathione reductase activity and homocysteine levels in patients with ischemic stroke and their clinical significance

目的探讨缺血性脑卒中患者血清谷胱甘肽还原酶(GR)活性及同型半胱氨酸(Hcy)水平的变化及临床意义。方法收集2020年9至12月浙江大学医学院附属金华医院治疗的首发缺血性脑卒中患者100例(研究组)及健康体检者100例(对照组),分别检测两组对象血清GR活性与Hcy水平并进行比较。采用二元logistic回归分析缺血性脑卒中的危险因素,Spearman相关分析GR与Hcy的相关性,ROC曲线分析GR、Hcy单独检测及联合检测对缺血性脑卒中的诊断效能。结果研究组GR活性为48(42,53)U/L,Hcy水平为13.6(11.7,15.8)μmol/L,对照组GR活性为61(52,72)U/L,Hcy水平为10.4(8.5,11.6)μmol/L,研究组GR活性低于对照组而Hcy水平高于对照组(均P<0.01)。二元logistic回归分析显示血清GR活性降低(OR=0.916,95%CI:0.867~0.968,P<0.05)和Hcy水平升高(OR=1.654,95%CI:1.309~2.091,P<0.01)是缺血性脑卒中的独立危险因素。GR活性与Hcy水平呈负相关(r=-0.571,P<0.01)。GR诊断缺血性脑卒中的AUC为0.823(95%CI:0.763~0.882,P<0.01),最佳截断值为58.5 U/L时,灵敏度为0.97,特异度为0.57;Hcy诊断缺血性脑卒中的AUC为0.842(95%CI:0.786~0.898,P<0.01),最佳截断值为12.5μmol/L时,灵敏度为0.71,特异度为0.92;两者联合诊断缺血性脑卒中的AUC为0.873(95%CI:0.824~0.921,P<0.01),灵敏度为0.83,特异度为0.80。结论缺血性脑卒中患者血清GR活性降低而Hcy水平升高,GR活性与Hcy水平在缺血性脑卒中辅助诊断及风险监测中有指导意义。

Objective To investigate the glutathione reductase(GR)activity and homocysteine(Hcy)levels in patients with ischemic stroke and their clinical significance.Methods One hundred patients with initial ischemic stroke(study group)treated in Jinhua Hospital from September to December 2020 and 100 healthy subjects(control group)were enrolled in the study.The GR activity and Hcy level of the two groups were determined and compared.Binary logistic regression was used to analyze the factors related to ischemic stroke,and Spearman correlation analysis was used to study the correlation between GR and Hcy.The diagnostic efficacy of GR and/or Hcy in diagnosis for ischemic stroke was analyzed by ROC curve.Results The GR activity in the study group was significantly lower than that in the control group[48(42,53)U/L vs.61(52,72)U/L,P<0.01],while the Hcy level was higher than that in the control group[13.6(11.7,15.8)μmol/L vs.10.4(8.5,11.6)μmol/L,P<0.01].Binary logistic regression analysis showed that decreased serum GR activity(OR=0.916,95%CI:0.867-0.968,P=0.002)and increased Hcy level(OR=1.654,95%CI:1.309-2.091,P=0.000)were independently related to ischemic stroke.There was a negative correlation between GR activity and Hcy level(r=-0.571,P<0.01).The area under the ROC curve(AUC)of GR in the diagnosis of ischemic stroke was 0.823(95%CI:0.763-0.882,P<0.01).When the optimal cutoff value was 58.5 U/L,the sensitivity was 0.97 and the specificity was 0.57.The AUC of Hcy in the diagnosis of ischemic stroke was 0.842(95%CI:0.786-0.898,P<0.01),and using 12.5μmol/L as the cutoff value,the sensitivity was 0.71 and the specificity was 0.92.The AUC of combined GR with Hey for diagnosis of ischemic stroke was 0.873(95%CI:0.824-0.921,P<0.01),the sensitivity was 0.83 and the specificity was 0.80.Conclusion GR activity is significantly decreased and Hcy level is significantly increased in patients with ischemic stroke,suggesting that GR activity and Hcy level might be used for the auxiliary diagnosis and risk monitoring of ischemic stroke.