Hcy、hs-CRP、Cys-C和sdLDL-C在急性缺血性脑卒中诊断中的价值

A Study on the Expression and Diagnosis Values of Hcy,Hs-CRP,Cys-C and sdLDL-C Indicators in Acute Ischemic Stroke

目的探讨同型半胱氨酸、超敏C反应蛋白、胱抑素C和小而密低密度脂蛋白胆固醇在急性缺血性脑卒中(acute ischemic stroke,AIS)的表达水平及诊断价值。方法选取2020年1月至2021年12月本院收治的急性缺血性脑卒中366例为观察组,同期本院体检正常健康者179例为对照组,检测两组的同型半胱氨酸(homocysteine,Hcy)、超敏C反应蛋白(hypersensitive-CRP,hs-CRP)、胱抑素C(cystatin C,Cys-C)和小而密低密度脂蛋白胆固醇(small and dense LDL cholesterol,sdLDL-C)4项指标的水平。统计学分析采用Deepwise&Beckman Coulter DxAI Platform(https://dxonline.deepwise.com)进行分析,相关因素分析采用多元Logistic回归,诊断效能评价采用ROC曲线进行。结果观察组Hcy、hs-CRP、Cys-C和sdLDL-C表达水平均明显高于对照组(P<0.05。Logistic回归分析结果显示,4项指标均是AIS的发病相关的风险因素。ROC曲线结果显示,4项指标均对AIS的诊断有价值,在单一指标比较中,Hcy和hs-CRP诊断效能相对较高,Hcy诊断AIS的灵敏度和特异性分别为94.8%和73.2%,AUC为0.867。hs-CRP诊断AIS的灵敏度和特异性分别为69.7%和88.3%,AUC为0.854。而在联合诊断分析结果显示,Hcy+hs-CRP、Hcy+hs-CRP+sdLDL,Hcy+hs-CRP+Cys-C和Hcy+hs-CRP+sdLDL+Cys-C 4种组合的AUC分别为0.919、0.916、0.918和0.924,通过Z检验分析,此4种组合的AUC间差异无统计学意义(P>0.05),而与其他组合或单一指标相比差异有统计学意义(P<0.05)。结论Hcy、hs-CRP、Cys-C和sdLDL-C对AIS有一定的诊断价值,为了提高诊断效能,Hcy和hs-CRP两项指标的联合诊断最佳。

Objective To study the relationship between the blood Hcy,hs-CRP,Cys-C and sdLDL-C indicators and acute ischemic stroke.Methods From January,2020 to December,2021,366 acute ischemic stroke patients who met the criteria of stroke diagnosis in Beijing Tiantan Hospital were included in the study group,and 179 healthy people as control group.Levels of Hcy,hs-CRP,Cys-C and sdLDL-C were measured by automatic biochemical analyzer,and the results were statistically analyzed.Variance analysis was used for comparison of measurement data,and Z tests were used for case number and rate distribution.ROC curve was used for evaluating diagnosis value,and Deepwise&Beckman Coulter DxAI Platform(https://dxonline.deepwise.com)was used for all tests.Results Levels of Hcy,hs-CRP,Cys-C and sdLDL-C in the acute ischemic stroke group were higher than those in the control group(P<0.05).For the single index,the area under the curve of Hcy and hs-CRP were the largest(0.867 and 0.854).The area under the curve of the combined diagnosis of Hcy+hs-CRP,Hcy+hs-CRP+sdLDL,Hcy+hs-CRP+Cys-C and Hcy+hs-CRP+sdLDL+Cys-C were the largest and AUC were 0.919,0.916,0.918 and 0.924,respectively.There were no significant differences of the levels of 4 AUC by Z test.Conclusion Hcy,hs-CRP,Cys-C and sdLDL-C have diagnostic value in the acute ischemic stroke.Compared with single index,the combined diagnosis of Hcy+hs-CRP is more efficient.