心源性栓塞型脑梗死患者血清LDL和PCT的水平变化及临床意义

Changes and Clinical Significance of the Level of Serum LDL and PCT in Patients with Cardiogenic Embolic Cerebral Infarction

目的探讨心源性栓塞型脑梗死(cardioembolic cerebral infarction,CECI)患者血清中低密度脂蛋白(low density lipoprotein,LDL)和降钙素原(procalcitonin,PCT)在疾病进展过程中的水平变化以及在评估CECI患者病情和预后中的价值。方法选取2018年1月~2020年12月在郑州大学附属郑州中心医院神经内科被诊断为CECI的300例患者为病例组,按照1∶1配对的原则,选取同期在笔者医院进行健康体检的300例志愿者为对照组。对照组空腹采集静脉血3ml,病例组分别在入院后0、1、3、5和7天收集静脉血3ml,通过ELISA法检测样本中血清LDL和PCT的水平,病例组在入院7天后通过美国国立卫生研究员中分量表(national institutes of health stroke scale,NIHSS)评分评估患者预后情况,受试者工作特征(receiver operating characteristic,ROC)曲线用于评估低密度脂蛋白(low-density lipoprotein,LDL)和PCT对CECI的诊断效能。结果与对照组比较,CECI患者血清LDL和PCT水平显著增加,在入院后第3天达到高峰,第5天开始下降,第7天左右恢复到健康人群水平,差异有统计学意义(P<0.05)。与治疗无效组比较,治疗有效组CECI患者的血清LDL和PCT明显降低(P<0.05),呈现出预后效果越好,血清LDL和PCT水平越低的趋势。LDL和PCT对CECI诊断均具有较好的诊断效能(AUC>0.80),进行联合诊断时效能最高(AUC=0.96)。结论CECI患者血清LDL和PCT水平会跟随疾病进展过程发生动态变化,对LDL和PCT水平的动态监测有助于评估患者的病情和预后。

Objective To explore the changes of the lowdensity lipoprotein-cholestol(LDL-C)and procalcitonin(PCT)levels in patients with cardioembolic cerebral infarction(CECI),andvalues of LDL and PCT levels in evaluating the condition and prognosis of patients with CECI were investigated.Methods 300 patients were divided as the case group who were diagnosed as CECI in the Department of Neurology,Zhengzhou Central Hospital Affiliated to Zhengzhou University between January 2018 to December 2020,and the healthy individuals who were matched in age and sex in the hospital in the same period were divided as the control group.In the control group,3ml of venous blood was collected.In the case group,3ml of venous blood was collected on the 0th day,1st,3rd,5th,and 7th day of admission.The expression levels of serum LDL and PCT in the samples were detected by ELISA.In the case group,the prognosis of the patients was evaluated by the National Institutes of Health Stroke Scale(NIHSS)score 7 days after admission.Receiver operating characteristic(ROC)was used to assess diagnostic efficiency of LDL and PCT on CECI.Results Compared with healthy individuals,the levels of serum LDL and PCT in patients with CECI increased significantly,which reached the peak at the 3rd day and continuously declined after the 5th day,and returned to the level of healthy individuals around the 7th day.The difference was statistically significant(P<0.05).Compared with the treatment-ineffective group,the serum LDL and PCT of the CECI patients in the treatment-effective group were significantly lower(P<0.05),showing a trend that the better the prognosis,the lower the serum LDL and PCT levels.ROC curve showed that both LDL and PCT had good diagnostic efficiency(AUC>0.80)for the diagnosis of CECI,and combined diagnosis showed highest accuracy(AUC=0.96).Conclusion The level of serum LDL and PCT in patients with CECI follows the dynamic process of disease progression.The dynamic monitoring of serum LDL and PCT levels can improve evaluation of the condition and prognosis of patients.