摘要
目的探讨穿支动脉粥样硬化病(BAD)患者血清高敏C反应蛋白(hs-CRP)、小而密低密度脂蛋白胆固醇(sdLDL-C)、脂蛋白磷脂酶A2(Lp-PLA2)、胱抑素C(Cys C)、尿酸/肌酐(UA/Cr)比值与早期神经功能恶化(END)的关系。方法前瞻性纳入2020年7月至2023年1月郑州人民医院神经内科收治的BAD患者235例,根据入院7 d内第2次美国国立卫生研究院卒中量表(NIHSS)评分中的运动评分项增加≥1分或总分增加≥2分定义END,将患者分为END组56例和非END组179例。记录患者入院时血清hs-CRP、sdLDL-C、Lp-PLA2、Cys C、UA/Cr比值。用多因素logistic回归分析BAD患者发生END的独立影响因素,用ROC曲线分析血清hs-CRP、sdLDL-C、Lp-PLA2、Cys C、UA/Cr比值预测END的准确性。结果END组患者sdLDL-C、hs-CRP、Lp-PLA2、Cr、Cys C、出院时NIHSS评分、发病后3个月时改良的Rankin量表评分高于非END组,男性、UA、UA/Cr比值低于非END组(P<0.05,P<0.01)。多因素logistic回归分析显示,hs-CRP(OR=1.160,95%CI:1.044~1.290,P=0.006)、sdLDL-C(OR=4.756,95%CI:1.994~11.344,P=0.000)、Cys C(OR=4.555,95%CI:2.191~9.470,P=0.000)、Lp-PLA2(OR=1.025,95%CI:1.013~1.037,P=0.000)是BAD患者发生END的独立危险因素,UA/Cr比值(OR=0.424,95%CI:0.280~0.642,P=0.000)是BAD患者发生END的保护性因素。ROC曲线分析显示,血清hs-CRP、sdLDL-C、Lp-PLA2、Cys C、UA/Cr比值5项指标联合检测END的AUC为0.853(95%CI:0.791~0.916),敏感性和特异性分别为75.0%和84.4%。结论临床检测血清hs-CRP、sdLDL-C、Lp-PLA2、Cys C、UA/Cr比值可作为BAD患者发生END的独立预测因子,联合检测有助于患者病情评估。
Objective To investigate the relationship of serum high-sensitivity C-reactive protein(hs-CRP),small and dense low-density lipoprotein cholesterol(sdLDL-C),lipoprotein phospholipase A2(Lp-PLA2),cystatin C(Cys C),and uric acid/creatinine(UA/Cr)ratio with early neurological deterioration(END)in patients with branch atheromatous disease(BAD).Methods A total of 235 BAD patients admitted to our department from July 2020 to January 2023 were prospectively enrolled in this study.END was defined when the score of motor item in the second NIHSS within 7 d of admission was increased by≥1 point or the total score was increased by≥2 points,and then the patients were divided into an END group(56 cases)and a non-END group(179 cases).The serum levels of hs-CRP,sdLDL-C,Lp-PLA2 and Cys C and UA/Cr ratio were recorded at the time of admission.Multivariate logistic regression analysis was used to explore the risk factors for END in BAD patients,and ROC curve analysis was employed to identify the accuracy of above 5 indicators in predicting END.Results The END group had significantly higher serum levels of sdLDL-C,hs-CRP,Lp-PLA2,Cr and Cys C,increased NIHSS score at discharge,and elevated mRS score in 3 month after onset,but lower male ratio,UA level and UA/Cr ratio when compared with the non-END group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that hs-CRP(OR=1.160,95%CI:1.044-1.290,P=0.006),sdLDL-C(OR=4.756,95%CI:1.994-11.344,P=0.000),Cys C(OR=4.555,95%CI:2.191-9.470,P=0.000)and Lp-PLA2(OR=1.025,95%CI:1.013-1.037,P=0.000)were independent risk factors for END,while,UA/Cr ratio(OR=0.424,95%CI:0.280-0.642,P=0.000)was a protective factor for END in the BAD patients.ROC curve analysis indicated that the AUC value of combined serum levels of hs-CRP,sdLDL-C,Lp-PLA2 and Cys C and UA/Cr ratio together for END was 0.853(95%CI:0.791-0.916),with a sensitivity and specificity of 75.0%and 84.4%,repectively.Conclusion Serum levels of hs-CRP,sdLDL-C,Lp-PLA2 and Cys C and UA/Cr ratio can be used as independent predictors fo
作者
朱利利
付胜奇
胡胜洁
禹萌
张洪涛
宋良
刘海涛
Zhu Lili;Fu Shengqi;Hu Shengjie;Yu Meng;Zhang Hongtao;Song Liang;Liu Haitao(Department of Neurology,Zhengzhou People's Hospital,the Fifth Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou 450003,Henan Province,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2024年第4期413-417,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
河南省医学科技攻关计划项目(SB201903029)。
关键词
C反应蛋白质
尿酸
肌酸酐
神经病学表现
穿支动脉粥样硬化病
小而密低密度脂蛋白胆固醇
C-reactive protein
uric acid
creatinine
neurologic manifestations
branch atheroma-tous disease
small and dense lowdensity lipoprotein cholesterol
