代鸣明,于航,苏庆杰,龙发青,吴映曼,王德生,张余辉,陈斌,王布飞,肖英,高畅
DAI Mingming,YU Hang,SU Qingjie,LONG Faqing,WU Yingman,WANG Desheng,ZHANG Yuhui,CHEN Bin,WANG Bufei,XIAO Ying,GAO Chang

• 1:海南医学院第二附属医院神经内科
• 2:海南医学院第二附属医院重症医学科
• 3:海南省医学院病理生理学教研室

摘要(Abstract)：

目的:探讨血清同型半胱氨酸(HCY)联合神经元特异性烯醇化酶(NSE)检测对进展性脑梗死(PCI)的预测价值。方法:200例急性脑梗死患者,根据发病24 h内头颅磁共振(MRI-DWI)结果分为大梗死灶组(n=39)、中梗死灶组(n=83)及小梗死灶组(n=78),根据病情进展情况分为进展组(n=78)及非进展组(n=122),分别于发病第1、2、3、7及14天时检测患者血清HCY、NSE水平,发病第1及7天时采用NIHSS评分、改良Barthel指数(MBI)评分评估患者神经功能缺血症状;比较3组不同大小脑梗死灶患者第1天的血清HCY、NSE水平,比较进展组及非进展组患者发病第1、2、3、7及14天时的血清HCY、NSE水平,采用Pesrson相关法分析进展性脑梗死患者NIHSS评分、MBI评分与NSE、HCY水平的相关性。结果:脑梗死各组第1天时的血清HCY、NSE水平随病灶的增大而升高(P<0.05),进展组患者第1、2、3及7天时血清HCY、NSE水平高于非进展组(P<0.05),第14天时2组患者HCY、NSE水平比较,差异无统计学意义(P>0.05);进展组患者在发病后第1、2及3天时血清HCY、NSE水平逐渐升高,第7天后逐渐降低;Pearson相关分析结果显示,进展性脑梗死患者发病第1及7天时的血清HCY、NSE水平与患者NHISS、MBI评分呈正相关(P<0.01)。结论:血清HCY、NSE联合检测能可反映脑梗死神经功能损害程度,可作为进展性脑梗死的有效预测指标。
Objective: To investigate the prediction value of combined homocysteine( HCY) and neuron specific enolase( NSE) in progressive cerebral infarction. Methods: 200 patients with acute cerebral infarction were selected. According to the results of MRI-DWI sequence in the head within 24 hours of illness,the patients were divided into large( n = 39),medium( n = 83) and small( n = 78)infarction groups. The patients were further divided into progression group( n = 78) and non-progression group( n = 122); NSE and HCY levels were tested on the 1~(st),2~(nd),3~(rd),7~(th) and 14~(th) day; NIHSS score and modified Barthel index( MBI) score were adopted to assess the neurological deficit score of patients on the 1 stand 7 th day after onset of illness. Comparing serum HCY and NSE level on the 1 st day after admission of three groups; comparing serum HCY and NSE level of both progression and nonprogression groups on the 1~(st),2~(nd),3~(rd),7~(th) and 14~(th) day; Pearson correlation analysis was used to analyze the correlation between NIHSS score,MBI score and NSE,HCY levels in patients with progressive cerebral infarction. Results: on the 1 stday,the levels of serum HCY and NSE increased with the development of the lesion( P < 0. 05); on the 1~(st),2~(nd),3~(rd) and 7~(th) day,serum NSE and HCY of progression group were significantly higher than those of non-progression group. There was no significant difference on the 14~(th) day of the HCY and NSE comparison between both groups( P > 0. 05). 1~(st),2~(nd) and 3~(rd) day after the onset of illness,serum HCY and NSE level increased gradually in progression group and decreased gradually on the 7~(th) day. According to Pearson analysis,the levels of serum NSE and HCY in patients with progressive cerebral infarction were positively correlated with NIHSS score and MBI score P < 0. 01). Conclusion: Serum HCY and NSE combined detection can reflect the degree of neurological damage in cerebral infarction,which may be an effective predictor of progressive cerebral infarction.

关键词(KeyWords)： 脑梗塞,进展性;同型半胱氨酸;神经元特异性烯醇化酶;美国国立卫生研究院卒中量表;改良Barthel指数
cerebral infarction,progressive;homocysteine;neuron specific enolase;National Institutes of Health Stroke Scale;Modified Barthel Index

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81660270);; 海南省卫计委行业科研项目(1601032054A2001);; 海南医学院科研培育基金(HY2016-07)

作者(Author): 代鸣明,于航,苏庆杰,龙发青,吴映曼,王德生,张余辉,陈斌,王布飞,肖英,高畅
DAI Mingming,YU Hang,SU Qingjie,LONG Faqing,WU Yingman,WANG Desheng,ZHANG Yuhui,CHEN Bin,WANG Bufei,XIAO Ying,GAO Chang

DOI: 10.19367/j.cnki.1000-2707.2018.08.015

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