急性缺血性脑卒中患者血清淀粉样蛋白A、脂蛋白磷脂酶A2、同型半胱氨酸水平变化及临床意义

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摘要目的探究急性缺血性脑卒中患者血清淀粉样蛋白A（SAA）、脂蛋白磷脂酶A2（Lp-PLA2）、同型半胱氨酸（Hcy）水平的变化、临床意义及诊断效能。方法选取2017年5月～2018年5月江苏省苏州市中西医结合医院（以下简称“我院）收治的122例急性缺血性脑卒中患者为实验组，测定其血清SAA、Lp-PLA2、Hcy水平，根据美国国立卫生研究院卒中量表（NIHSS）将其分轻度组（n = 44）、中度组（n = 25）、重度组（n = 53），根据梗死灶面积将其分为大面积组（n = 59）、中面积组（n = 25）、小面积组（n = 38）。另选取我院同期健康人群50名作为对照组。对实验组和对照组、实验组不同亚组间血清SAA、Lp-PLA2、Hcy水平进行比较，采用受试者工作特征（ROC）曲线评估血清SAA、Lp-PLA2、Hcy在急性脑卒中患者中的诊断价值。结果实验组血清SAA、Lp-PLA2、Hcy水平均显著高于对照组（P ＜ 0.01）。实验组中不同严重程度组、不同梗死面积组患者血清SAA、Lp-PLA2、Hcy水平比较，差异有高度统计学意义（P ＜ 0.01），随着神经功能损伤严重程度的加重、梗死面积的增大，血清SAA、Lp-PLA2、Hcy水平逐渐上升。三者联合检测对急性脑卒中的诊断效能要优于单独检测的诊断效能。结论急性缺血性脑卒中患者的血清SAA、Lp-PLA2、Hcy水平显著升高，且随着病情严重程度和梗死面积的增加而升高。三者联合检测对急性缺血性脑卒中患者的早期诊断、筛查及判断脑梗死严重程度有重要意义。

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	张坦罗毅张强

关键词 ：急性缺血性脑卒中, 血清淀粉样蛋白A, 脂蛋白磷脂酶A2, 同型半胱氨酸, 诊断效能

Abstract：Objective To investigate the level changes, clinical significance and diagnostic efficacy of serum amyloid A (SAA), lipoprotein phospholipase A2 (Lp-PLA2) and homocysteine (Hcy) in patients with acute ischemic stroke. Methods One hundred and twenty-two patients with acute ischemic stroke admitted to Suzhou Hospital of Integrated Chinese and Western Medicine (“our hospital” for short) from May 2017 to May 2018 were selected as the experimental group, and their serum levels of SAA, Lp-PLA2 and Hcy were measured. The patients were divided into mild group (n = 44), moderate group (n = 25) and severe group (n = 53) according to the National Institutes of Health stroke scale (NIHSS), and the patients were divided into large area group (n = 59), medium area group (n = 25) and small area group (n = 38) according to the area of the infarct. Another 50 healthy people in the same period in our hospital were selected as the control group. The serum levels of SAA, Lp-PLA2 and Hcy were compared between the experimental group and the control group, and between different subgroups of the experimental group. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic values of serum SAA, Lp-PLA2, Hcy in patients with acute ischemic stroke. Results The serum levels of SAA, Lp-PLA2 and Hcy in the experimental group were significantly higher than those in the control group (P ＜ 0.01). In the experimental group, there were highly significant differences in serum levels of SAA, Lp-PLA2 and Hcy in groups with different degrees of severity and groups with different infarct areas (P ＜ 0.01), the serum levels of SAA, Lp-PLA2 and Hcy gradually increased with the aggravation of nerve function injury and the increase of infarction area. The diagnostic efficacy of combined detection of the three indicators for acute stroke was better than that of single detection. Conclusion The serum levels of SAA, Lp-PLA2 and Hcy in patients with acute ischemic stroke are significantly increased, which are increased with the increase of severity and infarct area. The combined detection of the three indicators is of great significance for the early diagnosis, screening and determination of the severity of cerebral infarction in patients with acute ischemic stroke.

Key words： Acute ischemic stroke Serum amyloid A Lipoprotein phospholipase A2 Homocysteine Diagnostic efficacy

基金资助:江苏省中医药局科技项目（YB2015101）；
江苏省苏州市科技计划项目（SYS201270）。

作者简介: 张坦（1982.3-），男，副主任医师；研究方向：脑血管病。

引用本文:

张坦罗毅张强. 急性缺血性脑卒中患者血清淀粉样蛋白A、脂蛋白磷脂酶A2、同型半胱氨酸水平变化及临床意义[J]. 中国医药导报, 2019, 16(23): 77-81.
ZHANG Tan LUO Yi ZHANG Qiang. Level changes and clinical significance of serum amyloid A, lipoprotein phospholipase A2 and homocysteine in patients with acute ischemic stroke. 中国医药导报, 2019, 16(23): 77-81.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2019/V16/I23/77

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