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血清同型半胱氨酸和神经胶质原纤维酸性蛋白水平变化在急性脑梗死患者中的临床意义
作者:张欣1  齐凡星1  李静2  李志安1  康丽娟1  刘露1  孙静1 
单位:1. 保定市第一中心医院神经内科, 河北 保定 071000;
2. 保定市第一中心医院彩超室, 河北 保定 071000
关键词:血清同型半胱氨酸 神经胶质原纤维酸性蛋白 急性脑梗死 
分类号:R743.3
出版年·卷·期(页码):2019·47·第五期(508-512)
摘要:

目的:探讨急性脑梗死(ACI)患者血清同型半胱氨酸(HCY)与神经胶质原纤维酸性蛋白(GFAP)水平的变化,分析HCY和GFAP对ACI患者的临床意义。方法:应用酶联免疫吸附法(ELISA)检测92例ACI患者(ACI患者组)和40例非ACI患者(对照组)血清HCY、GFAP水平。依据美国国立卫生研究院卒中量表(NIHSS)评分、发病时间及梗死面积等将ACI患者进一步分组,比较不同组别血清HCY、GFAP水平差异,构建受试者工作特征(ROC)曲线,获取HCY、GFAP在脑梗死诊断中的阳性与阴性的临界值及诊断敏感度与特异度。结果:ACI患者组HCY、GFAP水平分别为(18.26±5.37)μmol·L-1、(1.28±0.64)μg·L-1,均高于对照组的(7.41±3.46)μmol·L-1、(0.69±0.37)μg·L-1(均P<0.01);发病时间12~24 h组血清HCY水平高于发病时间<12 h组(P<0.05);小面积梗死(SI)组血清HCY及GFAP水平最低,大面积梗死(LI)组最高,差异均有统计学意义(P<0.01);NIHSS评分<4分组HCY及GFAP水平最低,>15分组最高,差异均有统计学意义(P<0.01)。血清HCY与GFAP水平呈正相关(r=0.514,P=0.001),HCY与合并高血压、发病时间、梗死面积、NIHSS评分呈正相关,GFAP与合并高血压、梗死面积、NIHSS评分呈正相关,多因素分析发现合并高血压、梗死面积、NIHSS评分为血清HCY和GFAP水平的独立危险因素;ROC分析显示,HCY、GFAP诊断ACI的最佳界值分别为15.03 μmol·L-1、1.02 μg·L-1结论:ACI患者血清HCY和GFAP水平明显升高,且与ACI的病情严重程度有一定的相关性,可为ACI早期诊断及治疗提供依据。

Objective:To investigate serum levels of homocysteine (HCY) and glial fibrillary acidic protein (GFAP) in patients with acute cerebral infarction (ACI) and its clinical significance. Methods:Serum HCY and GFAP levels were measured by enzyme-linked immunosorbent assay (ELISA) in 92 patients with ACI and40 patients with non-ACI were included in the control group. The subjects were grouped with the National Institutes of Health Stroke Scale (NIHSS) score, onset time and infarct size. The differences in serum HCY and GFAP levels in different groups were analyzed. The receiver operating characteristic (ROC) curve was constructed to obtain the positive and negative threshold values and diagnostic sensitivity and specificity of HCY and GFAP in the diagnosis of cerebral infarction. Results:The levels of HCY and GFAP in ACI patients were (18.26±5.37) μmol·L-1 and (1.28±0.64) μg·L-1, which were significantly higher than those in the control group (P<0.01). The serum HCY level in the 12-24 h group was higher than the <12 h group (P<0.05). The expression of serum HCY and GFAP was the lowest in the small area infarction (SI) group and the highest in the large area infarction (LI) group, the difference was statistically significant (P<0.01). The NIHSS score <4 group had the lowest HCY and GFAP levels, and the NIHSS sore>15 group was the highest, the difference was statistically significant (P<0.01). There was a positive correlation between serum HCY and GFAPlevels (r=0.514, P=0.001). HCY was positively correlated with hypertension, onset time, infarct size, and NIHSS score. GFAP was positively correlated with hypertension, infarct size, and NIHSS score. Logistic regression analysis found that hypertension, infarct size, and NIHSS score were independent risk factors for serum HCY and GFAP expression levels. ROC analysis showed that the best cutoff value of HCI and GFAP for diagnosis of ACI were 15.03 μmol·L-1, 1.02 μg·L-1. Conclusion:The levels of serum HCY and GFAP in the patients with ACI are significantly increased, and have a certain correlation with the severity of ACI, which can provide a basis for early diagnosis and treatment of ACI.

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