不同TOAST分型急性脑梗死患者血脂谱、胆红素与谷氨酰转移酶水平变化及临床意义

The Changes and Clinical Significance of Blood Lipid profile, Blirubin and GGT in Acute Cerebral Infarction Patients with Different TOAST Classification

目的 探讨不同TOAST分型急性脑梗死患者血脂谱、胆红素、谷氨酰转移酶(GGT)水平变化及临床意义。方法 选取2019年1月至2020年12月广东省农垦中心医院收治的急性脑梗死患者77例作为研究对象,依据TOAST分型标准进行分型,分别为24例大动脉粥样硬化型脑梗死(LAA),27例小动脉闭塞型脑梗死(SAO),6例心源性栓塞型脑梗死(CE),17例不明原因型脑梗死(SUE),3例其他病因型脑梗死(SOE),测定不同分型组的血脂亚型[同型半胱氨酸(Hcy)、胱抑素C(Cys-C)、低密度脂蛋白(LDL)]、胆红素[直接胆红素(DBIL)与间接胆红素(IBIL)]、GGT水平。对各型患者给予统一治疗,评定预后。结果 不同TOAST分型组的血脂亚型指标水平、胆红素水平、GGT水平均不相同,Cys-C水平最高为LAA组[(1.17±0.18)mg/L],最低CE组[(0.81±0.15)mg/L];Hcy最高为LAA组[(13.64±2.95)mg/L],最低SOE组[(6.09±1.64)mg/L];LDL最高为LAA组[(3.83±1.08)mmol/L],最低CE组[(3.03±1.05)mmol/L];IBIL、DBIL、GGT水平最高为LAA组,而SOE组水平最低。在预后方面,CE组美国国立卫生院卒中量表(NIHSS)评分最高[(3.05±1.26)分],最低为SAO组[(1.26±0.52)分];后遗症发生率最高为CE组(66.67%),最低SAO组(11.11%)。结论 对血脂谱、胆红素、GGT水平进行联合测定,无论在明确急性脑梗死患者的发病机制上,还是在评估其病因分类方面,均有重要价值。

Objective To explore the changes and clinical significance of blood lipid profile, bilirubin and GGT in acute cerebral infarction patients with different TOAST classification. Methods 77 patients with acute cerebral infarction admitted to Guangdong Agricultural Reclamation Center Hospital from January 2019 to December 2020 were selected as the study objects, and were classified according to the TOAST classification standard, including 24 patients with large atherosclerotic cerebral infarction(LAA), 27 patients with small artery occlusion cerebral infarction(SAO), 6 patients with cardiac embolic cerebral infarction(CE),17 patients with unexplained cerebral infarction(SUE), and 3 patients with other etiological cerebral infarction(SOE), The levels of blood lipid subtypes [homocysteine(Hcy), cystatin C(Cys-C), low-density lipoprotein(LDL)], bilirubin [direct bilirubin(DBIL)and indirect bilirubin(IBIL)] and GGT in different groups were measured.All types of patients were treated and the prognosis was evaluated. Results The blood lipid subtype index level, bilirubin level and GGT level of different toast typing groups are different,The highest Cys-C level was in LAA Group [(1.17±0.18) mg/l], the lowest CE Group [(0.81±0.15) mg/l];the highest Hcy level was in LAA Group [(13.64±2.95)mg/l], the lowest SOE Group [(6.09±1.64) mg/l];the highest LDL level was in LAA Group [(3.83±1.08)mmol/l], and the lowest CE Group [(3.03±1.05)mmol/l];The levels of IBIL, DBIL and GGT were the highest in LAA group and the lowest in SOE group. In terms of prognosis, the NIHSS score in CE group was the highest [(3.05±1.26) points]and the lowest in SAO Group [(1.26±0.52) points], and the incidence of sequelae was the highest in CE group(66.67%) and the lowest in SAO group(11.11%). Conclusion The combined determination of blood lipid profile, bilirubin and GGT levels is of great value not only in clarifying the pathogenesis of patients with acute cerebral infarction, but also in evaluating the etiological classification of patients with acute cerebral infarction.