血脂、血糖联合同型半胱氨酸检测在急性脑梗死神经功能及预后评估中的作用分析

Analysis of the effect of serum lipids,blood glucose combined with homocysteine in the evaluation of neurological function and prognosis in acute cerebral infarction

目的:探讨血脂、血糖联合同型半胱氨酸(Homocysteine,Hcy)检测在急性脑梗死(Acute cerebral infarction,ACI)神经功能及预后评估中的作用。方法:选取2021年10月至2022年10月期间本院神经内科收治ACI患者98例作为研究对象。根据入院时的美国国立卫生研究院卒中量表评分对神经功能缺损程度行评价,并按照神经功能缺损程度的不同将ACI患者分为轻度组、中度组和重度组。出院后,对患者随访3 m,采用改良Rankin量表(Modified Rankin scale,mRS)评分评估患者的预后情况,并根据患者的预后情况的不同,将其分为两组:预后良好组和预后不良好组。比较不同神经功能缺损程度及预后情况ACI患者的血脂、血糖及Hcy水平。评价血脂、血糖及Hcy水平对ACI预后的预测效能。绘制ROC曲线,并计算AUC。结果:总胆固醇(total cholesterol,T-CHO)、甘油三脂(Triglyceride,TG)、高密度脂蛋白胆固醇(High density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDL-C)、Hcy、血红蛋白(Hemoglobin,HbAlc)、空腹血糖及餐后2 h血葡萄糖(Blood glucose 2 hours after meal,2hPG)水平比较:重度组>中度组>轻度组、预后不良好组>预后良好组。HDL-C水平比较:重度组<中度组<轻度组、预后不良好组<预后良好组,差异具有统计学意义(P<0.05)。血脂+血糖+Hcy联合诊断的灵敏度、特异度分别为90.88%、87.92%,且AUC(95%CI)为0889(0.853-0.949),均显著高于血脂相关指标、血糖相关指标、Hcy的单一检测(P<0.05)。结论:血脂、血糖联合Hcy与ACI神经功能及预后情况存在密切联系,而联合上述指标检测可提高ACI预后的预测价值。

Objective:To investigate the role of serum lipids,blood glucose combined with homocysteine(Hcy)in the evaluation of neurological function and prognosis in acute cerebral infarction(ACI).Methods:98 patients with ACI admitted to the Department of Neurology of our hospital from October 2021 to October 2022 were selected as the study objects.The degree of neurological impairment was evaluated according to the National Institutes of Health Stroke Scale(NIHSS)score at admission,and ACI patients were divided into mild group,moderate group,and severe group according to the degree of neurological impairment.After discharge,the patients were followed up for 3 months,and the prognosis of the patients was evaluated by using the modified Rankin Scale(mRS)score,and according to the different prognosis of the patients,they were divided into two groups:good prognosis group and poor prognosis group.To compare the levels of blood lipid,blood glucose and Hcy in ACI patients with different degree of neurological impairment and prognosis.To evaluate the prognostic efficacy of blood lipid,blood glucose and Hcy levels in ACI.Plot the ROC curve and calculate the AUC.Results:The levels of T-CHO,TG,LDL-C,Hcy,HbAlc,fasting blood glucose and 2hPG were compared:severe group>moderate group>mild group,poor prognosis group>good prognosis group.Comparison of HDL-C levels:severe group<moderate group<mild group,poor prognosis group<good prognosis group,the difference was statistically significant(P<0.05).The sensitivity and specificity of combined diagnosis of lipid+blood glucose+Hcy were 90.88%and 87.92%,respectively,and AUC(95%CI)was 0889(0.853-0.949),which were significantly higher than those of serum lipid related index,blood glucose related index and single detection of Hcy(P<0.05).Conclusion:The combination of blood lipid,blood glucose and Hcy is closely related to the neurological function and prognosis of ACI,and the combination of these indicators can improve the prognostic value of ACI.