缺血性卒中急性期患者血清半胱氨酸蛋白酶抑制剂C水平的变化

目的探讨血清半胱氨酸蛋白酶抑制剂C（简称胱抑素C）与缺血性卒中的相关性及临床意义。方法收集急性缺血性卒中患者147例，按病灶体积分为小、中、大3个亚组，根据美国国立卫生研究院卒中量表（NIHSS）分为高危组（NIHSS〉8分）和低危组（NIHSS≤8分），选择60例非卒中患者为对照组。采用颗粒增强免疫比浊法测定血清胱抑素c水平，探讨胱抑素c与缺血性卒中的关系，并分析胱抑素c与缺血性卒中的相关性。结果①缺血性卒中组患者血清胱抑素c水平为（1．20±0．40）mg／L，高于对照组的（0．86±0．23）mg／L，差异有统计学意义，P〈0．05。随着病灶体积的增加，血清胱抑素c水平也升高，差异有统计学意义，F=10．447，P〈0．05。②卒中复发组患者的血清胱抑素C水平为（1．33±0．52）mg／L，高于卒中初发组的（1．12-4-0．28）mg／L，差异有统计学意义，P〈0．01。③血清胱抑素c水平与NIHSS评分无相关性，但高危组患者的胱抑素c水平（1．37±0．68）mg／L]高于低危组的胱抑素c水平（1．15±0．27）mg／L]，差异有统计学意义，P〈0．01。④血清胱抑素c水平与同型半胱氨酸（Hcy，r=0．189，P=0．022）和极低密度脂蛋白（r：0．255，P=0．002）呈正相关，与高密度脂蛋白（r=-0．173，P=0．036）呈负相关；⑤多因素Logistic回归分析显示，血清胱抑素c为缺血性卒中的危险因素（OR=2．646，95％CI1．621-4．317，P〈0．01）。结论血清胱抑素C水平升高是缺血性卒中的独立危险因素，与缺血性卒中病灶大小及严重程度有关，血清胱抑素c水平可作为缺血性卒中发生、发展及病情监测的参考指标。

Clinical significance of serum cystatin C in patients with acute ischemic stroke

Objective To investigate the correlation and clinical significance of serum cystatin C (Cys-C) level and ischemic stroke.Methods A total of 147 patients with acute ischemic stroke were recruited. They were divided into small,medium and large sub-groups according to the infarct volume of the brain.They were also divided into high-risk group(the National Institute of Health Stroke Scale > 8) and low-risk group(NIHSS≤8) according to the scores of NIHSS.Sixty patients without stroke were selected as a control group.A particle enhanced immunoturbidimetric assay was used to detect the serum Cystain C levels,investigate the relationship between Cystain C level and ischemic stroke and analyze the correlation between Cystain C level.Results①The serum Cystain C level 1.20±0.40rng/L in the ischemic stroke group was significantly higher than 0.86±0.23 mg/L in the control group.The difference was statistically significant(P <0.05).With the increase in infarct volume,the serum Cystain C level also increased.The difference was statistically significant(P<0.05).②The serum Cystain C level 1.33±0.52 mg/L in a stroke recurrence group was higher than 1.12±0.28 mg/L in a initial stroke group.The difference was statistically significant(P< 0.01).③The serum Cystain C level has no correlation with the NIHSS score, but the serum Cystain C level 1.37±0.68 mg/L in the high risk group was higher than 1.15±0.27 in the low risk group.The difference was statistically significant(P<0.01 ).④The serum Cystain C level was positively correlated with homocysteine(Hcy)(r =0.189,P =0.022) and very low density lipoprotein cholesterol(VLADL-C)(r=0.255,P =0.002),however,it was negatively correlated with high density lipoprotein cholesterol(HDL-C)(r= -0.173,P = 0.036).⑤Multivariate logistic regression analysis showed that the serum Cystain C was a risk factor for ischemic stroke(OR = 2.646,95%CI 1.621- 4.317,P<0.01 ).Conclusion The increased serum Cystain C level is an independent risk factor for ischemic stroke,it is associated with the lesion size and the severity of cerebral infarction.The serum level may be used as a reference indicator for the occurrence and development of cerebral infarction and disease surveillance.