脂蛋白氧化修饰-低密度脂蛋白凝血四项指标与大面积脑梗死患者美国国立卫生研究院卒中量表评分的关系及临床意义

Relationship and clinical significance of changes in Lp(a),ox-LDL,and changes in four coagulation indicators and NIHSS score in patients with large-scale cerebral infarction

目的分析脂蛋白(a)[Lp(a)]、氧化修饰-低密度脂蛋白(ox-LDL)、凝血四项指标变化与大面积脑梗死(CI)美国国立卫生研究院卒中量表(NIHSS)评分的关系及临床意义。方法选取2019年10月至2021年6月在河南省平顶山市第二人民医院就治的116例大面积CI患者,根据其入院时NIHSS评分分为中度组(61例)、重度组(55例),并根据预后效果[改良Rankin量表(mRS)评分]分为预后良好组(69例)、预后不良组(47例),测定所有患者Lp(a)、ox-LDL、凝血四项指标[凝血酶原时间(PT)、纤维蛋白原(FIB)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)],比较各组间Lp(a)、ox-LDL、PT、FIB、TT、APTT水平,并进行相关分析。结果与重度组对比,中度组Lp(a)、ox-LDL、FIB水平较低,PT、TT、APTT较高(P<0.05);预后良好组Lp(a)、ox-LDL、FIB水平较预后不良组低,PT、TT、APTT较预后不良组高(P<0.05);大面积CI患者Lp(a)、ox-LDL、FIB水平均与NIHSS评分、mRS评分呈正相关(r=0.468,0.502,0.417,0.459,P均<0.05),PT、TT、APTT水平均与NIHSS评分、mRS评分呈负相关(r=-0.467,-0.488,-409,-0.426,-0.472,-0.413,P<0.05)。结论大面积CI患者Lp(a)、ox-LDL、凝血四项指标存在异常表达的情况,且与神经功能缺损程度、预后效果具有紧密联系,测定其水平对临床判定患者病情程度、评估预后效果具有重要作用。

Objective To analyze the relationship and clinical significance of the changes in the four indexes of lipoprotein(a)[Lp(a)],oxidatively modified-low-density lipoprotein(ox-LDL),and coagulation with the National Institutes of Health Stroke Scale(NIHSS)scores of large cerebral infarction(CI).Methods One hundred and sixteen patients with large-area CI who attended the Second People′s Hospital of Pingdingshan City from October 2019 to June 2021 were selected and divided into a moderate group(61 cases)and a severe group(55 cases)according to their NIHSS scores at admission.According to the prognostic outcome[modified Rankin Scale(mRS)score],the patients were divided into a good prognosis group(69 cases)and a poor prognosis group(47 cases).Four indexes of Lp(a),ox-LDL,prothrombin time(PT),fibrinogen(FIB),prothrombin time(TT),and activated partial thromboplastin time(APTT)were measured in all the patients,and the levels of Lp(a),ox-LDL,PT,FIB,TT,and APTT were compared and correlated among the groups.Results Compared with the severe group,the moderate group had lower Lp(a),ox-LDL,and FIB levels and higher PT,TT,and APTT(P<0.05).Compared with the poor prognosis group,the good prognosis group had lower levels of Lp(a),ox-LDL,and FIB levels and higher levels of PT,TT,and APTT(P<0.05);in patients with massive CI,the levels of Lp(a),ox-LDL and FIB were positively correlated with NIHSS score and mRS score(r=0.468,0.502,0.417,0.459,P<0.05),and the levels of PT,TT and APTT were negatively correlated with NIHSS score and mRS score(r=-0.467,-0.488,-409,-0.426,-0.472,-0.413,P<0.05).Conclusion Lp(a),ox-LDL,and coagulation indices were abnormally expressed in patients with massive CI,is closely related to the degree of neurological impairment and the prognostic effect.The determination of their levels is important for the clinical determination of the degree of the patient′s disease and the assessment of the prognosis.