脑梗死患者血清高敏C反应蛋白水平的变化及其临床意义

目的　探讨脑梗死患者血清高敏C反应蛋白(hsCRP)水平的变化及其与脑梗死严重程度的关系。方法　测定93例脑梗死患者和44名健康人的血清hsCRP含量,并分析其与脑梗死患者临床神经功能缺损程度评分的相关性。结果　脑梗死组血清hsCRP水平明显高于正常对照组(P<0. 01)。脑梗死不同临床分型组间血清hsCRP水平比较,重型组明显高于中型、轻型组,差异均有显著性(均P<0 .05)。脑梗死患者血清hsCRP含量与临床神经功能缺损程度评分呈正相关(r=0 .252,P<0 .05)。结论　血清hsCRP水平增高与脑梗死的发生和严重程度有密切关系,hsCRP可能是脑梗死发病的一个危险因素。     

急性脑梗死与C反应蛋白和脂蛋白的相关性分析

目的探讨急性脑梗死患者超敏C反应蛋白(hs-CRP)和脂蛋白检测与脑梗死发病的相关性。方法检测128例急性脑梗死患者(观察组)治疗前后的血清hs-CRP及LP(a)水平;120例正常对照者(对照组)来自我院体检中心的健康体检者,亦检测其hs-CRP及LP(a)水平。结果急性脑梗死患者治疗前后的CRP和LP(a)检测结果都明显高于正常对照组,差异有统计学意义(P<0.05);急性脑梗死患者治疗前CRP检测值明显高于治疗后,差异有统计学意义(P<0.05);而LP(a)治疗前后的检测结果差异无统计学意义(P>0.05)。结论高水平血清LP(a)浓度为脑血管疾病的重要危险因素。急性脑梗死患者hs-CRP显著升高,且hs-CRP检测结果的高低与病情呈正相关关系。LP(a)和hs-CRP对急性脑梗死有重要的辅助诊断和监测病情作用。     

首次脑梗死患者血清超敏C反应蛋白与动脉硬化指数的相关性分析

目的探讨首次脑梗死(ACI)患者超敏C-反应蛋白(hsCRP)与动脉硬化指数(AIP)的相关性及其临床意义。方法随机选取60例首次脑梗死患者,对其进行神经功能缺损评分,检测各组患者血清hsCRP及TCH,TG,HDL-C,LDL-C等水平,计算动脉硬化指数;选取35例体检健康者作为对照组。结果ACI患者血清hsCRP,TG水平及AIP明显高于对照组,并且无论是脑梗死组还是对照组,hsCRP水平与动脉硬化指数无相关性。结论hsCRP与脑梗死的发生有密切关系,可能是独立于TG和L-DLC,H-DLC以外的脑梗死相关危险因素;AIP与脑梗死有关。     

复发性脑梗死与血清超敏C反应蛋白关系探讨

目的观察脑梗死初发、复发患者血清CRP水平,探讨脑梗死复发与血清CRP的关系。方法用免疫透射比浊法测定200例急性脑梗死患者及100例非急性脑卒中患者的血清CRP水平,并进行分析。结果各类型急性脑梗死患者血清CRP均高于非急性脑卒中患者(P<0.01);各类型脑梗死患者之间血清CRP差异无统计学意义(P>0.05)。脑梗死复发患者血清CRP高于初发患者(P<0.01),且高血清CRP比率亦高于初发患者(P<0.05)。各类型脑梗死复发患者之间血清CRP差异无统计学意义(P>0.05)。结论脑梗死复发患者血清CRP高于初发患者提示脑梗死复发与血清CRP升高有一定关系,高血清CRP是脑梗死复发的独立性危险因素。     

血管内皮损伤因子ACA、hsCRP与颈动脉斑块的关系

目的探讨抗心磷脂抗体(ACA)、超敏C反应蛋白(hsCRP)与颈动脉斑块性质的关系及ACA与hsCRP之间的关系。方法采用彩色多普勒超声对脑梗死患者双侧颈总动脉及颈内动脉进行探查,并与正常对照组同时测定血清hsCRP及ACA水平。结果①颈动脉斑块各亚组血清hsCRP均高于正常对照组(P<0.05);不稳定性斑块组血清hsCRP水平高于稳定性斑块组(P=0.001,P=0.046);无论斑块是否稳定,动脉狭窄程度越高,血清hsCRP水平越高(P=0.000,P=0.001);②颈动脉斑块各组血清ACA-IgG均高于正常对照组(P<0.05);不稳定斑块组ACA-IgG高于稳定斑块组(P=0.024);无论斑块是否稳定,血清ACA-IgG水平与管腔狭窄程度无关(P=0.884,P=0.757);血清ACA-IgA、ACA-IgM在各亚组中均无统计学差异(P>0.05)。③血清hsCRP与ACA-IgG有相关性(r=0.238,P=0.011)而与ACA-IgA、ACA-IgM无相关性。结论hsCRP不仅是反映炎症的指标,同时还可以反映斑块的稳定性和病变程度,hsCRP与ACA均为颈动脉病变的敏感指标和预测指标,hsCRP和ACA-IgG二者相互影响,共同促进颈动脉粥样硬化的发生、发展。检测hsCRP、ACA水平将有助于了解斑块的活动及转归,为颈动脉斑块的早期干预和脑血管病的二级预防提供参考依据。     

急性脑梗死患者甲状腺激素水平变化临床分析

目的探讨急性脑梗死患者甲状腺激素水平变化及其临床意义。方法动态观察60例急性脑梗死患者治疗前后甲状腺激素水平,同时检测40例健康对照者甲状腺激素水平,并对2组及治疗前后进行比较。结果与对照相比,治疗前脑梗死组血清FT3降低(P<0.01),TSH、FT4与对照组相比差异无统计学意义(P>0.05)。脑梗死组治疗前后相比,治疗前血清FT3水平低(P<0.05),TSH、FT4差异无统计学意义(P>0.05)。脑梗死治疗后FT3、FT4、TSH水平与对照组相比无统计学意义(P>0.05)。结论脑梗死患者急性期FT3下降,随着病情好转逐渐恢复;治疗前后甲状腺激素水平的变化的测定,对于监测治疗和判断预后有一定临床意义。     

2型糖尿病合并急性脑梗死hs-CRP、Lp(a)检测的临床价值

目的探讨2型糖尿病(DM)合并急性脑梗死(ACI)患者检测高敏C反应蛋白(hs-CRP)、脂蛋白a[Lp(a)]的临床价值。方法收集42例2型糖尿病合并急性脑梗死病例(DM+ACI组),40例单纯T2DM(DM组)及同期40例健康体检者(正常对照组),测定3组人群的hs-CRP、Lp(a)及其他生化指标,并对结果进行统计学分析。结果 DM+ACI组及DM组的血清hs-CRP、Lp(a)水平均显著高于正常对照组(P<0.05)。DM+ACI组血清Lp(a)显著高于DM组(P<0.05),2组hs-CRP水平比较差异无统计学意义(P>0.10)。结论 hs-CRP、Lp(a)检测对2型糖尿病并发急性脑梗死的风险度具有一定的预测价值。     

超敏C反应蛋白与脑卒中病变程度的相关性分析

目的 研究脑卒中患者超敏C反应蛋白(hsCRP)与脑卒中严重程度的关系.方法 选择急性脑梗死组88例、脑出血组87例、静息性脑梗死87例与非脑卒中组87例分别测定、比较各组间hsCRP水平差异.结果 急性脑梗死组、脑出血组的hsCRP水平,显著高于静息性脑梗死组和非脑卒中组,差异有统计学意义(P＜0.05).NIHSS评分1～9分组及≥10分组血清hsCRP水平比较也有极显著差异(P＜0.01).结论 hsCRP与脑卒中的发生有密切关系,hsCRP水平在一定程度上能反应脑卒中的严重程度.     

血清超敏C反应蛋白与急性脑梗死的相关性研究

目的探讨血清超敏C反应蛋白(hsCRP)水平与急性脑梗死病情严重程度及危险因素的关系。方法采用全自动生化分析仪测定186例动脉粥样硬化性血栓性脑梗死(ACI)及155例腔隙性脑梗死(LI)患者的血清hsCRP、血糖、血脂等指标,并与329名健康者进行对照。同时对急性脑梗死患者血清hsCRP水平与病情进行相关分析。结果ACI组和LI组的hsCRP水平显著高于正常对照组(均P<0.05);hsCRP水平与急性脑梗死患者神经功能缺损程度相关(P<0.05);hsCRP水平与ACI组年龄、舒张压、血糖、三酰甘油水平呈正相关(r=0.261、0.222、0.261、0.166,均P<0.05),与LI组患者的年龄、收缩压、血糖、总胆固醇水平呈正相关(r=0.294、0.456、0.245、0.402,均P<0.05),与高密度脂蛋白水平负相关(r=-0.371,P<0.05)。结论hsCRP水平与急性脑梗死的病情严重程度明显相关;并与其危险因素相关。     

血清高敏C反应蛋白水平与脑梗死关系的研究

目的探讨血清高敏C反应蛋白(hsCRP)水平与脑梗死病情及预后的关系。方法测定90例急性脑梗死患者入院时血清hsCRP含量,观察梗死灶大小不同、神经功能缺损程度不同时含量变化,应用美国国立卫生研究院卒中量表(NIHSS)及Barthel指数(BI)分别对患者入院时及治疗6个月后进行评分,并将血清hsCRP水平与NIHSS及BI评分进行相关性分析。同时选取80例健康体检人员血清hsCRP含量进行对照。结果脑梗死患者血清hsCRP含量明显高于健康对照组(P<0.01);脑梗死血清hsCRP水平越高,梗死灶越大,神经功能缺损程度越重;患者血清hsCRP水平与入院时NIHSS呈显著正相关(P<0.01),与6个月后BI评分呈显著负相关(P<0.01)。结论血清hsCRP水平是临床评价脑梗死严重程度和预后的一个重要生物学指标。     

Association Study of CRP Gene and Ischemic Stroke in a Chinese Han Population

High-sensitivity C-reactive protein (hsCRP) was reported as a strong, independent predictor of future myocardial infarction and stroke. It is of importance to illustrate the conformance of CRP genetic variation, increment of plasma hsCRP and cerebral events. A case–control study including 548 patients with acute ischemic stroke and 993 age-matched controls from community-based population was conducted and four tagging SNPs (tagSNPs) were genotyped. Multiple logistic regression was applied to evaluate the association of CRP gene and stroke hsCRP elevation with adjustment for covariates. The results indicated that rs3093059 and rs3091244 presented statistical associations with ischemic stroke. Odds ratios (ORs) (95 % confidence interval [CI]) of additive model, dominant model and minor allele at rs3093059 were 0.697 (0.528–0.921), 0.671 (0.487–0.923) and 0.811 (0.666–0.988), and ORs (95 % CI) of dominant model at rs3091244 was 0.728 (0.536–0.988), after adjusting for covariates. But there were no significant differences of genotype or allele frequencies of the four SNPs observed between hypertension (HT) and normal blood pressure (NBP) groups. Further analyses indicated the genetic variations of rs876537 and rs3093059 were positively associated with increased square root transformed hsCRP and hsCRP elevation (≥3 mg/l) in ischemic stroke patients, and rs876537 and rs3091244 were associated with hsCRP elevation in controls as well. Our finding suggests that the CRP genetic polymorphisms were associated with decreased risk of ischemic stroke and elevated plasma hsCRP and further replication study and functional research would be warranted.     

速避凝与丹参对缺血性脑卒中患者血浆中基质金属蛋白酶-9的影响

目的 通过对分别采用速避凝和丹参治疗的两组缺血性脑卒中患者血浆中的基质金属蛋白酶-9(MMP-9)水平的测定,探讨速避凝和丹参对缺血性脑卒中患者血浆中MMP-9含量的影响。方法 选取32例发病时间在24小时内的脑卒中急性期病例,按年龄匹配原则随机分成速避凝组16例,丹参组16例;采用酶联免疫吸附检测方法(ELISA)测定脑缺血后24小时内、第3天和第7天时血浆中MMP-9的含量。结果 脑缺血后24小时内(治疗前)、治疗后第3天和第7天时两组血浆内MMP-9含量都在上升;第3天和第7天时的含量均比发病时显著升高(P<0.001),第7天的含量比第3天的含量略高一点,但无明显差异(P>0.05);速避凝组治疗后3天内MMP-9含量增加值小于相同时间的丹参治疗组(P<0.05);7天内MMP-9水平上升值两组之间无显著差异(P=0.297)。结论 速避凝与丹参不能抑制或阻止缺血性脑卒中患者血浆中MMP-9含量上升;与丹参治疗组相比,速避凝能减少患者血浆中早期MMP-9含量的增加。     

急性脑梗死患者外周血Th17、Treg、Th17/Treg及炎症因子的动态变化过程研究

目的探讨急性脑梗死(AIS)患者外周血Th17、Treg、Th17/Treg及相关炎症因子的表达及其动态演变过程。方法选取32例AIS患者为实验组及32名健康人为对照组。分别检测AIS患者第1 d、4 d、7 d,外周血中Th17及Treg占CD4+T细胞比例及Th17/Treg比值,并检测白介素6(IL-6)、中性粒细胞与淋巴细胞比值(NLR)、C反应蛋白(CRP)和红细胞沉降率(ESR),分析其在AIS后的变化规律。结果AIS组于起病后第1 d、4 d,外周血Th17、Treg比例分别与对照组相比,差异有统计学意义(均P<0.05);AIS患者第7 d Th17、Treg比例逐渐恢复,与对照组比较差异无统计学意义(均P>0.05);AIS患者Th17/Treg比值在第1 d、4 d、7 d逐渐减小,但始终明显高于对照组(均P<0.05)。在AIS后的第1 d、4 d、7 d,IL-6、NLR及CRP分别均明显高于对照组(均P<0.05);AIS患者ESR第1 d与对照组比较无统计学意义(P>0.05),第4 d、7 d明显高于对照组(均P<0.05)。AIS患者外周血Th17比例及Th17/Treg、NLR、CRP、ESR分别与IL-6呈正相关(ρ=0.298,P=0.007;ρ=0.351,P=0.001;ρ=0.377,P=0.001;ρ=0.582,P=0.000;ρ=0.388,P=0.000);Treg比例与IL-6呈负相关(ρ=-0.242,P=0.029)。结论AIS患者早期存在Th17/Treg失衡,且合并有全身炎症反应。     

脑梗死患者急性期血清高敏C-反应蛋白的动态变化及临床意义

目的　探讨急性脑梗死(ACI)患者高敏C-反应蛋白(hsCRP)的含量变化及其临床意义。方法　随机选择60例急性脑梗死患者,利用Dade-Behring ProSpec全自动特定蛋白分析系统,采用散射免疫比浊法检测各组患者hsCRP血清水平,观察ACI不同病程含量变化。并对其神经功能缺损进行标准评分。并选取30例健康体检者作为对照组。结果　急性脑梗死组不同时期血清hsCRP含量均高于对照组(P <0.05),卒中后第7天水平最高,随后逐渐下降;血清hsCRP含量与神经功能缺损程度呈正相关(r =0.53,P <0.01),重型患者hsCRP浓度明显高于轻、中型患者。结论　急性脑梗死患者血清hsCRP明显升高,且与神经功能缺损程度呈正相关,可作为急性脑梗死患者病变稳定程度的敏感指标之一。     

新疆地区急性脑卒中患者临床特征的性别差异研究

目的探讨新疆地区不同性别急性脑卒中患者临床特点的差异性。方法前瞻性连续登记新疆生产建设兵团医院自2008年6月～2011年7月收治的急性脑卒中患者971例,其中男性598例,女性383例,收集相关临床资料,并对所有患者进行长期随访,比较男女脑卒中患者一般资料、卒中类型、牛津郡社区脑卒中分型(OC-SP分型)、相关并发症、及预后方面的不同。结果新疆地区急性脑卒中患者临床类型存在性别差异(P=0.017),急性脑梗死及脑出血男性比例高于女性,短暂性脑缺血发作(TIA)患者女性比例高于男性;男性患者在高血压构成比(P<0.001)、房颤(P=0.011)、吸烟(P<0.001)、酗酒(P<0.001)、凝血酶原时间(PT)(P=0.039)、血红蛋白含量(HGB)(P<0.001)、肌酐值(P=0.001)高于女性患者,而女性患者在心脏瓣膜病(P=0.002)、糖尿病(P=0.013)、高密度脂蛋白(HDL)(P<0.001)、低密度脂蛋白(LDL)(P<0.001)、总胆固醇(CHE)(P<0.001)高于男性;OCSP分型男女性患者无显著差异;急性脑卒中相关并发症方面,女性患者泌尿系感染(P<0.001)、电解质紊乱(P=0.005)高于男性;基线严重程度评分Glasgow昏迷量表(GCS评分)、斯堪的那亚卒中量表(SSS评分)、美国国立卫生院脑卒中量表(NIHSS评分)与一个月及2年的Barthel指数(BI)和改良的Rankin量表(MRS评分)无明显差异。结论新疆地区不同性别间急性脑卒中临床类型、相关危险因素及卒中相关并发症存在差异,基线严重程度评分及临床预后无明显差异。     

青年急性脑梗死患者的危险因素及病因分型分析

目的探讨青年急性脑梗死患者的危险因素及病因分型。方法回顾性收集180例青年急性脑梗死患者为病例组,同期收集的150例门诊健康体检者为对照组,采用单因素χ2检验及多因素Logistic回归模型对危险因素进行分析。病因分析采用TOAST分型及国际儿童卒中研究(International Pediatric Stroke Study,IPSS)方法进行探讨。结果单因素χ2检验示高血压、高脂血症、吸烟、饮酒、高同型半胱氨酸的组间分布差异有统计学意义(P<0.05)。多因素Logistic回归分析示高同型半胱氨酸、高脂血症、吸烟和高血压的组间分布差异有统计学意义(P<0.05)。采用TOAST分型而被认定为不明原因脑梗死的24例患者,利用IPSS方法发现83%的患者有其他危险因素。结论高同型半胱氨酸血症可能是青年缺血性脑卒中的独立危险因素。采用IPSS方法可能为青年缺血性脑卒中特定病因分型的发展提供参考。     

急性脑梗死及颈动脉粥样硬化患者LPA和TNF水平研究

目的探讨溶血磷脂酸(LPA)及肿瘤坏死因子(TNF)在缺血性卒中发病中的作用。方法采用酶免法检测了160例急性期、38例恢复期脑梗死患者,58例颈动脉粥样硬化患者及35名健康者外周血LPA及TNF水平。结果急性期脑梗死患者LPA及TNF水平均较恢复期脑梗死及颈动脉粥样硬化患者高;恢复期脑梗死及颈动脉粥样硬化患者又较健康对照组高;恢复期脑梗死患者与颈动脉粥样硬化患者相比无统计学意义。结论LPA及TNF增高不仅是急性脑梗死缺血性损伤反应,而且在颈动脉粥样硬化患者已有增高,它们在缺血性卒中发病中发挥一定的作用。     

Clinical significance of new coagulation and fibrinolytic markers in ischemic stroke patients.

BACKGROUND AND PURPOSE: We investigated plasma levels of D-dimer products of crosslinked fibrin degradation products, thrombin-antithrombin III complex, and plasmin-alpha 2-antiplasmin complex for detecting coagulation system activation in ischemic stroke patients to determine the possible effect of age on these marker levels. METHODS: We measured plasma levels of these three markers in 54 acute ischemic stroke patients within 5 days of stroke onset, in 44 chronic ischemic stroke patients over 3 months from onset, and in 50 age-matched healthy subjects. We divided the stroke patients into two subgroups, those with visible occlusion and those with nonvisible occlusion having obstruction of the major cerebral artery. RESULTS: The plasma levels of these three markers were significantly (p less than 0.01) higher in the stroke patients than in controls. Significant differences did not exist at any level between the patients and controls in the younger-aged subjects (less than or equal to 64 years of age), but did exist in the older-aged subjects (greater than or equal to 75 years of age). An age-related increase of the marker levels was noted between stroke patients and controls. No significant difference in the three markers was found among any of the stroke patients. CONCLUSIONS: Increased levels of these markers in stroke patients seem to be related mostly to age.     

C-Reactive Protein Gene Contributes to the Genetic Susceptibility of Hemorrhagic Stroke in Men: a Case-Control Study in Chinese Han Population

High-sensitivity C-reactive protein (hsCRP) is an inflammatory marker for the prediction and prognosis of ischemic stroke but there is an absence of evidence for cerebral hemorrhagic events. The aim of this study is to investigate the effects of elevated plasma hsCRP and CRP genetic variants on hemorrhagic stroke (HS). Two hundred thirty-six inpatients with HS and 993 age-matched controls from a community-based population were included in a case-control study and four tagging single nucleotide polymorphsims (tagSNPs) at CRP were genotyped. The association of hsCRP elevation and CRP variants with HS was evaluated by multiple logistic regression. HS cases had a higher median (interquartile) of hsCRP with 5.40 (1.30–10.7) mg/L and a proportion of hsCRP elevation (≥3 mg/L, 63.4%) than controls [1.20 (0.80–2.20) mg/L, 16.6%], respectively (P < 0.05 for all). No significant difference of genotype or allele frequency of the four SNPs was observed between HS patients and controls (P > 0.05). Further stratified analysis by gender showed that the variants of rs3093059 (T/C) and rs3091244 (C/T/A) were significantly associated with the decreased risk of HS in men and odds ratios (ORs) and 95% confidence intervals (95% CIs) for additive models were 0.515 (0.294–0.903) and 0.578 (0.349–0.96), respectively, after adjusting for covariates. In HS patients, rs3091244 was positively associated with the hsCRP elevation and rs2794521 was negatively associated with hsCRP elevation (P < 0.05). Our findings suggest that hsCRP elevation is associated with the risk of HS and CRP contributes genetic susceptibility to HS in men as well as hsCRP elevation in HS.