血清Hcy CRP及谷氨酸水平与急性脑梗死患者神经功能损伤程度及预后的相关性

Correlation between Hcy,CRP,glutamate levels and neurological impairment degree,prognosis in patients with acute cerebral infarction

目的探讨血清同型半胱氨酸、C反应蛋白及谷氨酸水平与急性脑梗死患者神经功能损伤程度及预后的相关性。方法将120例急性脑梗死患者设为研究组,按梗死体积、美国国立卫生研究院卒中量表评分、改良Rankin量表生活自律程度标准分组,将120名健康体检者设为对照组。比较不同梗死体积、不同神经功能损伤程度患者与对照组同型半胱氨酸、C反应蛋白及谷氨酸水平,比较不同预后患者同型半胱氨酸、C反应蛋白及谷氨酸水平。评估同型半胱氨酸、C反应蛋白及谷氨酸水平单独及联合预测急性脑梗死患者预后的临床价值,分析急性脑梗死患者预后的影响因素。结果不同梗死体积患者血清同型半胱氨酸、C反应蛋白、谷氨酸水平均显著高于对照组(P<0.05),血清同型半胱氨酸、C反应蛋白、谷氨酸水平随脑梗死体积的增大而升高,差异有统计学意义(P<0.01)。不同神经功能损伤程度患者血清同型半胱氨酸、C反应蛋白、谷氨酸水平均显著高于对照组(P<0.05),重度损伤组血清同型半胱氨酸、C反应蛋白、谷氨酸水平显著高于轻度损伤组(P<0.05)。预后不良组血清同型半胱氨酸、C反应蛋白、谷氨酸水平显著高于预后良好组(P<0.01)。同型半胱氨酸、C反应蛋白、谷氨酸联合预测的曲线下面积大于同型半胱氨酸、C反应蛋白、谷氨酸单独预测的曲线下面积(P<0.05)。梗死体积、美国国立卫生研究院卒中量表评分、同型半胱氨酸、C反应蛋白及谷氨酸水平是急性脑梗死患者预后的影响因素(P<0.05或0.01)。结论血清同型半胱氨酸、C反应蛋白、谷氨酸水平与急性脑梗死患者梗死体积及神经功能受损程度相关,可作为判断预后的有效指标,值得临床推广。

Objective To investigate the correlation between homocysteine(Hcy),C-reactive protein(CRP),glutamate levels and neurological impairment degree,prognosis in patients with acute cerebral infarction(ACI).Methods A total of 120 ACI patients were set as the study group,grouped according to the volume of infarct lesions,the National Institutes of Health stroke scale(NIHSS),and the degree of self-discipline of the modified Rankin scale(mRS).Another 120 healthy subjects were set as the control group.The levels of Hcy,CRP and glutamate in patients with different infarction volume and neurological impairment were compared,and the levels of Hcy,CRP and glutamate in patients with different prognosis were compared.The clinical value of Hcy,CRP,glutamate and their combination in predicting prognosis of patients with ACI was evaluated.The influencing factors of prognosis in patients with ACI was analyzed.Results The levels of serum Hcy,CRP,and glutamate in patients with different infarction volume were significantly higher than those of the control group(P<0.05).The levels of serum Hcy,CRP,and glutamate increased with the increase of cerebral infarction volume,and the difference was statistically significant(P<0.01).The levels of serum Hcy,CRP and glutamate in patients with different levels of neurological impairment were significantly higher than those in the control group(P<0.05).The levels of serum Hcy,CRP and glutamate in the severe impairment group were significantly higher than those in the mild impairment group(P<0.05).The levels of serum Hcy,CRP and glutamate in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.01).The area under the curve(AUC) predicted by Hcy,CRP and glutamate was greater than that predicted by Hcy,CRP and glutamate alone(P<0.05).Infarction volume,NIHSS,Hcy,CRP and glutamate levels were the prognostic factors of ACI patients(P<0.05 or 0.01).Conclusions The levels of serum Hcy,CRP and glutamate are related to the infarction volume and the degree of neurological impairment in patients with ACI.It can be used as an effective indicator to judge the prognosis and is worthy of clinical promotion.