性激素、载脂蛋白和同型半胱氨酸水平与进展性缺血性脑卒中的相关性

目的 探讨性激素、载脂蛋白和同型半胱氨酸水平与进展性缺血性脑卒中(PIS)的相关性。方法 选58例进展性缺血性脑卒中患者当做观察组,62例非进展性缺血性脑卒中患者当做对照组,2组的年龄、性别等没有明显差异(P>0.05); AU480全自动生化分析仪(Beckman Coulter)对Hcy,Apo A1以及Apo B水平进行检测,荧光免疫法检测FSH,LH,T以及E₂水平,采用NIHSS评分评价患者神经功能,全自动血凝分析仪检测患者PT,FIB,APTT及PLT等凝血指标水平,ELISA检测血清中的TNF-α,IL-8,PCT水平,比浊法检测hs-CRP水平,并分析其性激素、载脂蛋白和HCY水平与进展性缺血性脑卒中的相关性。结果 观察组HCY,Apo B水平较对照组高(P<0.05),而Apo A1水平则较低(P<0.05); 2组FSH与LH水平之间没有明显差异(P>0.05); 与对照组比较,观察组男性患者具有较高的E₂水平(P<0.05),女性患者具有较低的E₂水平(P<0.05); 观察组男性患者的T水平有所降低(P<0.05),女性患者的T水平有所升高(P<0.05); 观察组的TNF-α,IL-8,PCT以及hs-CRP水平明显较对照组高(P<0.05); 与对照组比较,观察组的PT,APTT,PLT水平显著下降(P<0.05),FIB水平与NIHSS则较高(P<0.05); 相关性分析后发现,HCY、男性患者E₂、女性患者T水平与炎性因子、FIB水平、NIHSS呈正相关,与PT,APTT,PLT水平呈负相关,Apo A1/Apo B、女性患者中E₂、男性患者T水平与炎性因子、FIB水平、NIHSS呈负相关,与PT,APTT,PLT水平呈正相关; 通过Logistic回归分析得出E₂,T,HCY,Apo A1与Apo B对进展性缺血性脑卒中具有独立的预测价值,可作为其近期预后不良的危险因素。E₂,T,HCY水平,Apo A1/Apo B对进展性缺血性脑卒中具有较好的预测价值。结论 E₂与T的紊乱对于患者病情具有不佳的影响,HCY在PIS中的水平呈高表达,Apo A1/Apo B有所降低,且以上指标水平对于PIS具有一定的预测价值。

The correlation between sex hormone,apolipoprotein, homocysteine levels and progressive ischemic stroke

ObjectiveTo investigate the correlation between sex hormone, apolipoprotein, homocysteine levels and progressive ischemic stroke.Methods 58 patients with progressive ischemic stroke were selected as the observation group and 62 patients with non progressive ischemic stroke were selected as the control group. There was no obvious difference in age and gender between two groups. The levels of Hcy, Apo A1 and Apo B were tested by the AU480 automatic biochemical analyzer(Beckman Coulter), the levels of FSH, LH, T and E₂ were tested by the fluorescence immunoassay, and the neural function of the patients was asssessed by the NIHSS score. PT, FIB, APTT and PLT levels were detected by hemagglutination analyzer, TNF-α, IL-8, PCT levels in serum by ELISA, hs-CRP level by turbidimetry, and the relationship between sex hormone, apolipoprotein and Hcy levels and progressive ischemic stroke was analyzed.Results The levels of Hcy and Apo B in the observation group was higher than those in the control group(P<0.05), while the level of Apo A1 was lower(P<0.05). There was no obvious difference in the levels of FSH and LH between two groups(P>0.05). Compared with the control group, the level of E₂ in the observation group was obviously higher(P<0.05), and the level of E₂ in the female was significantly lower(P<0.05). The level of T in the observation group was significantly lower(P<0.05), and that in the female was significantly lower(P<0.05). Compared with the control group, PT, APTT and PLT levels in the observation group decreased significantly(P<0.05), while FIB level and NIHSS were higher(P<0.05). After the correlation analysis, it was indicated that Hcy level, E₂ level in male and T level in female were positively correlated with inflammatory factors, FIB levels and NIHSS, and negatively correlated with PT, APTT, PLT levels. Apo A1/Apo B, E₂ level in female patients, T level in male patients were negatively correlated with inflammatory factors, FIB levels, NIHSS, and positively correlated with PT, APTT, PLT levels. Logistic regression analysis showed that E₂, T, Hcy, Apo A1 and Apo B had independent predictive value for progressive ischemic stroke, which might be the risk factors for poor prognosis in the near future. E2, T, Hcy levels, Apo A1/Apo B had better predictive value for progressive ischemic stroke.Conclusion The disorder of E₂ and T had a bad effect on the patient's condition, Hcy level was highly expressed in PIS, Apo A1 / Apo B was decreased, and the above parameters had a certain predictive value for PIS.