2017 年第 10 期 第 12 卷

血清载脂蛋白A和N末端B型脑钠肽前体及同型半胱氨酸与急性脑梗死严重程度的关系

Relation among serum apolipoprotein-A, N-terminal pro-brain nitric peptide, homocysteine and severity of acute cerebral infarction

作者：蒲应香李玉鹏邢成文李鹏业马挺陈廷云

英文作者：Pu Yingxiang Li Yupeng Xing Chengwen Li Pengye Ma Ting Chen Tingyun

单位：810000西宁,青海仁济医院急诊内科

英文单位：Emergency Internal Medicine Renji Hospital of Qinghai Province Xining 810000 China

关键词：急性脑梗死；严重程度；载脂蛋白A；N末端B型脑钠肽前体；同型半胱氨酸

英文关键词：Acutecerebralinfarction；Severity；Apolipoprotein-A；N-terminalpro-brainnitricpeptide；Homocysteine

• 摘要：

• 目的 探讨血清载脂蛋白A、N末端B型脑钠肽前体（NT-proBNP）、同型半胱氨酸（Hcy）与急性脑梗死严重程度的关系。方法 选取2015年3月至2017年3月青海仁济医院收治的126例急性脑梗死患者作为观察组，选取同期125例健康体检者作为对照组；参照入院时美国国立卫生研究院卒中量表(NIHSS）评分将急性脑梗死患者按照严重程度分为轻度组（NIHSS评分＜5分，n=55）、中度组（NIHSS评分5～15分，n=36）与重度组（NIHSS评分＞15分，n=35）；并根据出院后90 d改良Rankin量表（mRS）评分将患者分为预后良好组（mRS评分≤2分，n=74）与预后不良组（mRS评分＞2分，n=52）。采用免疫比浊法检测血清载脂蛋白A水平，酶联免疫吸附试验法检测血清NT-proBNP水平，循环酶法检测血清Hcy水平。比较观察组与对照组、不同严重程度急性脑梗死和不同急性脑梗死预后状况患者血清载脂蛋白A、NT-proBNP、Hcy水平的差异，分析载脂蛋白A、NT-proBNP、Hcy水平与急性脑梗死严重程度（NIHSS 评分、mRS评分）的相关性。结果 观察组血清载脂蛋白A、NT-proBNP、Hcy水平均明显高于对照组［（541±128）mg/L比（205±51）mg/L、（416±91）ng/L比（50±7）ng/L、（29.6±10.4）μmol/L比（11.1±1.3）μmol/L］，差异均有统计学意义（均P＜0.001）。重度组血清载脂蛋白A、NT-proBNP、Hcy水平明显高于轻、中度组，中度组上述指标明显高于轻度组，差异均有统计学意义（均P＜0.001）。预后良好组血清载脂蛋白A、NT-proBNP、Hcy水平明显低于预后不良组，差异均有统计学意义（均P＜0.05）。Spearman相关性分析结果显示，血清载脂蛋白A、NT-proBNP、Hcy水平与NIHSS评分（r=0.521， P=0.009； r=0.615, P=0.008; r=0.571, P=0.009）、mRS评分（r=0.485， P=0.009； r=0.516, P=0.009; r=0.527, P=0.009）均呈明显正相关。结论 血清载脂蛋白A、NT-proBNP、Hcy水平与急性脑梗死严重程度具有紧密的关系，可作为病情严重程度的简易血清学评定指标。

• Objective To analyze the relation among serum apolipoprotein-A（APO-A）, N-terminal pro-brain nitric peptide（NT-proBNP）, homocysteine（Hcy） and severity of acute cerebral infarction. Methods From March 2015 to March 2017, 126 patients with acute cerebral infarction were enrolled as observation group and 125 healthy people were enrolled as control group in Renji Hospital of Qinghai Province. According to score of the National Institutes of Health Stroke Scale（NIHSS） at admission, the observation group was divided into mild group（score of NIHSS＜5 points, n＝55）, moderate group（score of NIHSS 5-15 points, n＝36） and severe group（score of NIHSS＞15 points, n＝35）. According to the score of modified Rankin Scale（mRS） 90 d after discharge, the observation group was divided into good prognosis group（score of mRS≤2 points, n＝4） and poor prognosis group（score of mRS＞2 points, n＝52）. APO-A was tested by immunoturbidimetric assay; NT-proBNP was tested by enzyme linked immunosorbent assay; Hcy was tested by enzymatic cycling assay. The relation among serum levels of APO-A, NT-proBNP, Hcy and severity of acute cerebral infarction（assessed by scores of NIHSS and mRS） was analyzed. Results Levels of APO-A, NT-proBNP and Hcy in observation group were significantly higher than those in control group［（541±128）mg/L vs （205±51）mg/L, （416±91）ng/L vs （50±7）ng/L, （29.6±10.4）μmol/L vs （11.1±1.3）μmol/L］（P＜0.001）. Levels of APO-A, NT-proBNP and Hcy increased with the score of NIHSS and there were significant differences among mild group, moderate group and severe group（P＜0.001）. Levels of APO-A, NT-proBNP and Hcy in good prognosis group were significantly lower than those in poor prognosis group（P＜0.05）. Spearman correlation analysis showed that levels of APO-A, NT-proBNP and Hcy were positively correlated with scores of NIHSS (r=0.521, P=0.009; r=0.615, P=0.008; r=0.571, P=0.009) and mRS (r=0.485, P=0.009; r=0.516, P=0.009; r=0.527, P=0.009). Conclusion Serum levels of APO-A, NT-proBNP and Hcy are related to severity of acute cerebral infarction.