目的 探讨血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平在急性脑梗死患者中的变化及临床意义。方法 选择2016-07—2017-01安阳市人民医院收治的急性脑梗死患者100例为观察组，按照梗死程度的不同将其分为小面积梗死组(n＝54)和大面积梗死组(n＝46)，并选择同期健康体检者为对照组，测定所有研究对象的脂蛋白相关磷脂酶A2和超敏C反应蛋白水平。结果 观察组患者的血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平均明显高于对照组(均P＜0.05)；相较于大面积梗死组，小面积梗死组的血清脂蛋白相关磷脂酶A
急性脑梗死患者血清脂蛋白相关磷脂酶A2和超敏C反应蛋白的变化及意义
杨新丽
安阳市人民医院神经内科，河南 安阳 455000
作者简介：杨新丽，Email：120172102@qq.com
【摘要】 目的 探讨血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平在急性脑梗死患者中的变化及临床意义。方法 选择2016-07—2017-01安阳市人民医院收治的急性脑梗死患者100例为观察组，按照梗死程度的不同将其分为小面积梗死组(n＝54)和大面积梗死组(n＝46)，并选择同期健康体检者为对照组，测定所有研究对象的脂蛋白相关磷脂酶A2和超敏C反应蛋白水平。结果 观察组患者的血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平均明显高于对照组(均P＜0.05)；相较于大面积梗死组，小面积梗死组的血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平均明显较高(均P＜0.05)。结论 急性脑梗死发病后，机体血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平会显著升高，且随着疾病严重程度的加深，其水平随之升高，两者关系呈正相关，可将两个指标作为急性脑梗死病情评估的参考指标，为其临床诊断和治疗提供指导。
【关键词】 急性脑梗死；脑卒中；磷脂酶A2；超敏C反应蛋白；病情评估
【中图分类号】 R743.33 【文献标识码】 A 【文章编号】 1673-5110(2018)20-2254-06 DOI：10.12083/SYSJ.2018.20.486
Changes and clinical significance of serum lipoprotein-associated phospholipase A2 and hypersensitive sputum reactive protein levels in patients with acute cerebral infarction
YANG Xinli
Department of Neurology，Anyang People′s Hospital，Anyang 455000，China
【Abstract】 Objective To investigate the changes and clinical significance of serum lipoprotein-related phospholipase A2 and high-sensitivity C-reactive protein levels in patients with acute cerebral infarction.Methods 100 patients with acute cerebral infarction admitted to our hospital from July 2016 to Jan 2017 were selected as observation group.According to the degree of infarction，they were divided into small infarction group (n＝54) and large infarction group (n＝46)，and selected the healthy physical examination in our hospital for the same period as the control group，the lipoprotein-associated phospholipase A2 and high-sensitivity C-reactive protein levels were determined in all subjects.Results The serum lipoprotein-associated phospholipase A2 and high-sensitivity C-reactive protein levels in the observation group were significantly higher than those in the control group (all P＜0.05)；equivalent to serum lipoprotein-related phospholipase in the large-area infarction group The levels of A2 and high-sensitivity C-reactive protein were significantly higher (all P＜0.05)．Conclusion After the onset of acute cerebral infarction，the levels of serum lipoprotein-related phospholipase A2 and hypersensitive c-reactive protein in the body will increase significantly，and as the severity of the disease deepens，the level will increase，and the relationship between them is positively correlated.Two indicators can be used as reference indicators for the assessment of acute cerebral infarction，providing guidance for their clinical diagnosis and treatment.
【Key words】 Acute cerebral infarction；Stroke；Phospholipase A2；Hypersensitive sputum reactive protein；Disease assessment
急性脑梗死也被称为缺血性脑卒中，在多种因素作用下，脑部出现血液供应障碍，从而导致脑组织缺血和缺氧，神经功能出现缺损[1-4]。近年来，我国急性脑梗死的发病率不断升高，急性脑梗死临床诊断的意义也更加凸显。炎性因子一般会导致脑缺血区域产生级联炎性反应，患者神经元以及脑水肿症状会加重，动脉粥样硬化更容易发生[5-8]。既往研究显示，血清脂蛋白相关磷脂酶A2和超敏C反应蛋白(CRP)水平在急性脑梗死诊断中具有重要作用[9-15]。本次研究旨在探讨血清脂蛋白相关磷脂酶A2和CRP在急性脑梗死患者中的变化及意义。
1 资料与方法
1．1 一般资料 选择2016-07—2017-01安阳市人民医院收治的急性脑梗死患者100例为观察组。纳入标准：均首次发病，并经MRI及CT检查确诊，且符合全国第4届脑血管学术会议急性脑梗的诊断标准；本次研究前未接受任何相关药物治疗。排除标准：所选急性脑梗死患者中已排除肿瘤患者、免疫系统疾病患者、全身性感染性疾病患者、糖尿病患者等。其中男59例，女41例，年龄41～75(59.72±4.33)岁。根据美国卫生研究院发布的脑卒中评分量表[16]，首次发生脑梗死＜24 h且梗死面积＜5 cm2的急性脑梗患者为小面积梗死组，＞5 cm2的患者为大面积脑梗死组。其中小面积梗死组(n＝54)，男28例，女26例，年龄40～77(60.24±4.26)岁；大面积梗死组(n＝46)，男26例，女20例，年龄41～76(59.53±4.42)岁。并选择同期在安阳市人民医院进行健康体检者为对照组，其中男60例，女40例，年龄40～74(59.10±4.52)岁。2组一般资料差异无统计学意义(P＞0.05)，具有可比性。本次研究经我院伦理委员会批准通过。
1．2 方法 所有研究对象均于清晨空腹状态下抽取其5 mL静脉血，将其放置于干燥试管中，对其进行离心处理，转速为3 000 r/min，测定2组患者的血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平，其中血清脂蛋白相关磷脂酶A2的测定采用酶联免疫法，采用美国Cayman公司提供的检测试剂盒，操作按照说明书执行；超敏C反应蛋白的测定采用乳胶颗粒增强速率散射比浊法。
观察组患者入院24 h后行CT及MRI检查。借助于MRI中的T2加权像及弥撒加权图像对患者的梗死灶部位予以确定。在其基础上，借助于CT检查结果，在PACS系统中对患者梗死灶的最长长度与宽度进行测量，获得梗死灶相对面积，并将其分为小面积梗死组及大面积梗死组。
1．3 统计学方法 采用SPSS 20.0统计软件包进行统计学分析，计量资料以均数±标准差(x±s)表示，采用t检验，计数资料以率(%)表示，采用卡方检验，P＜0.05为差异有统计学意义。
2 结果
2．1 观察组和对照组测定指标对比 观察组血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平均明显高于对照组，2组比较差异均有统计学意义(均P＜0.05)。见表1。
2．2 小面积梗死组和大面积梗死组测定指标对比 相较于大面积梗死组，小面积梗死组的血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平均明显较高，组间对比均存在显著性差异(P＜0.05)。见表2。
表1 观察组和对照组血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平对比 (x±s)
Table 1 Comparison of serum lipoprotein-related phospholipase A2 and high-sensitivity C-reactive protein levels in the observation group and the control group (x±s)
| 组别 |
n |
脂蛋白相关磷脂酶A2(ng/mL) |
超敏C反应蛋白(mg/L) |
| 观察组 |
100 |
298.42±120.57 |
11.48±3.53 |
| 对照组 |
50 |
130.15±52.49 |
2.31±1.05 |
| t值 |
|
9.420 |
17.949 |
| P值 |
|
0.000 |
0.000 |
表2 小面积梗死组和大面积梗死组血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平对比 (x±s)
Table 2 Comparison of serum lipoprotein-related phospholipase A2 and high-sensitivity C-reactive protein levels in small infarct group and large infarct group (x±s)
| 组别 |
n |
脂蛋白相关磷脂酶A2(ng/mL) |
超敏C反应蛋白(mg/L) |
| 小面积梗死组 |
54 |
238.15±60.02 |
7.95±2.50 |
| 大面积梗死组 |
46 |
355.02±103.45 |
13.79±3.04 |
| t值 |
|
8.745 |
12.531 |
| P值 |
|
0.000 |
0.000 |
3 讨论
急性脑梗死主要指脑血供突然中断后导致的脑组织坏死，是临床中一种常见的脑血管疾病[17-20]，该病的发病机制较为复杂，大脑动脉的狭窄和堵塞可由血管、血液及血力动力学异常所导致[21-29]。CT扫描诊断脑梗死较为方便，能够有效明确坏死脑组织的部位、大小以及脑水肿的程度。但是在疾病早期诊断方面，单纯CT检查具有一定的局限性，不能很好的满足诊断和治疗的需求[30-35]。导致脑梗死发生的基础病变是动脉粥样硬化，而动脉粥样硬化的发生与炎症反应又有密切联系[36-45]。颈动脉粥样硬化的超声改变主要为内膜增厚，管腔狭窄和斑块形成，内膜受到损害后会更容易形成动脉粥样硬化斑块。炎性细胞因子作为缺血性脑卒中发病的重要机制，其可中枢神经系统各类组织细胞产生，这些细胞因子同时也是重要的免疫介质，在脑缺血后炎症损伤过程中发挥着广泛的作用[46-55]。血清脂蛋白相关磷脂酶A2和超敏C反应蛋白都是机体内的炎症介质[56-57]。血清脂蛋白相关磷脂酶A2是一种磷脂酶，主要是由淋巴细胞和巨噬细胞分泌的，属于炎症介质。有研究指出，血清脂蛋白相关磷脂酶A2不仅与脑血管疾病的发生具有相关性，同时在促进动脉粥样硬化的发生和发展也有很大作用。因此对急性脑梗死具有一定的预测作用[58-59]。有学者指出，基线超敏C反应蛋白水平与心肌梗死和缺血性卒中的发生和发展具有相关性，能够预测疾病未来发生的风险[60]。急性脑梗死期患者发病2 h后，脑组织会由于局部脑缺血而发生病理性改变，促进机体释放炎性介质白细胞介素6，并在1L-6的诱导下产生细胞间黏附分子1，从而导致机体超敏C反应蛋白水平上升。有学者对急性脑梗塞患者展开研究，测定其发病48 h内的血清超敏C反应蛋白水平，并将其与入院后第10天的血清超敏C反应蛋白水平测定结果进行比较，两个测定结果具有显著差异，且水平呈负相关性，提示可能是由于脑梗死患者的炎症反应所致[61-62]。由此可见，血清超敏C反应蛋白与急性脑梗死的发生和发展密切相关。另外，超敏C反应蛋白水平在急性脑梗死患者发病早期可以从某种程度上促进分叶核自细胞吞噬细菌能力的提高，从而有效保护心脑血管。然而，若患者病情比较严重，机体血清超敏C反应蛋白含量过高，则又会损伤心脑血管，弊大于利。故本次研究中特对血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平进行检测，将其作为急性脑梗死患者的临床检测依据，并将检测结果同正常人体的指标含量进行对比，结果显示，急性脑梗死患者的血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平均显著高于健康体检组(均P＜0.05)，提示相较于正常人体而言，急性脑梗死患者的血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平表现为明显偏高。另外，在急性脑梗死不同疾病程度的测定结果对比中显示，相较于大面积梗死组，小面积梗死组的血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平均明显较高(均P＜0.05)，这与其他相关文献研究结果相符[63]，表示疾病越严重，其血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平则相应越高，两者呈正相关。因此，可对血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平这两项指标进行动态检验，将其作为评估急性脑梗死病情严重程度以及预后效果的重要依据。
急性脑梗死后机体血清脂蛋白相关磷脂酶A2和超敏C反应蛋白水平会显著升高，且随着疾病严重程度的加深，其水平随之升高，两者关系呈正相关，可将两个指标作为急性脑梗死病情评估的参考指标，为其临床诊断和治疗提供指导。
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(收稿2018-01-25 修回2018-08-11)
本文责编：王喜梅
本文引用信息：杨新丽．急性脑梗死患者血清脂蛋白相关磷脂酶A2和超敏C反应蛋白的变化及意义[J]．中国实用神经疾病杂志，2018，21(20)：2254-2259.DOI：10.12083/SYSJ.2018.20.486
Reference information：YANG Xinli.Changes and clinical significance of serum lipoprotein-associated phospholipase A2 and hypersensitive sputum reactive protein levels in patients with acute cerebral infarction[J]．Chinese Journal of Practical Nervous Diseases，2018，21(20)：2254-2259.DOI：10.12083/SYSJ.2018.20.486
