蛋白标志组早期诊断脑卒中的初步研究

目的分析5种蛋白指标早期诊断脑卒中的临床价值。方法用ELISA检测发病72h内的脑卒中患者174例，其中脑梗死（CI）85例，出血性脑卒中89例（含脑出血75例，蛛网膜下腔出血14例）、正常对照45例的血管性血友病因子（vWF）、S100β蛋白（S100β）、基质金属蛋白酶9（MMP-9）、单核细胞趋化蛋白1（MCP-1）、血管细胞黏附分子1（VCAM-1）水平，评估不同指标组合诊断脑卒中的敏感性和特异性。结果由vWF、S100β、MMP-9、MCP-1和VCAM-1组成诊断标志组，当其中任意3个指标的检测值高于各自的临界值时，判断结果为阳性，其诊断脑卒中的敏感度为81．03％，诊断发病6h内CI的敏感度为92．31％，特异度均为91．11％。在发病6h内，CI组与出血性脑卒中组相比，VCAM-1浓度显著升高，用VCAM-1鉴别经标志组诊断后的脑卒中患者，在发病6h内诊断CI的敏感度为69．23％，特异度70．89％。结论由vWF、S100β、MMP-9、MCP-1、VCAM-1组成的诊断标志组有助于脑卒中的早期诊断，对发病6h内CI的诊断敏感性高，并有助于该时段内CI与出血性脑卒中的鉴别。

Diagnosis of Stroke by a Biomarker Panel of Protein A Pilot Study

Objective To investigate the effect of early diagnosing stroke by combined detection of five proteins.Methods Patients with acute stroke within 72 hours were enrolled,including 85 patients of cerebral infarction（CI） and 89 patients of hemorrhagic stroke（75 patients of intracerebral hemorrhage and 14 patients of subarachnoid hemorrhage）. At the same time,45 healthy controls were enrolled. The concentration of yon Willebrand factor（vWF）, protein S100β（ S100β）, matrix metslloproteinase 9（ MMP-9）, monocyte chemotacfic protein 1 （MCP-1 ） and vascular cell adhesion molecule 1 （VCAM-1） in blood were detected by enzyme-linked immunosorbent assay（ELISA）. The protein panels were established from the permutation and combination of those 5 markers. The effect of diagnosing stroke by those panels was evaluated by sensitivity and specifitivity.Results The protein panel was consisted of vWF, S100β,MMP-9,MCP-1 and VCAM-1 ,with a sensitivity of 81.03% at 91.11% specificity for stroke, and it provided a sensitivity of 92.31% for CI samples taken within 6 hours from the symptom onset. In a panel algorithm in which three or more marker values were above their respective cutoffs were scored as positive. Patients with CI exhibited significantly increased plasma level of VCAM-1 compared with hemorrhagic stroke in 6 hours from the symptom onset. The sensitivity of VCAM-1 for the diagnosis of CI which was already evaluated by the panel of five proteins were 69.23% in die 6 hours from the symptom onset,and the specificity was 70.89% .Conclusion A protein panel composed of vWF, S100β, MMP-9, MCP-1 and VCAM-1 was helpful to diagnose stroke, especially for CI samples taken within 6 hours from the symptom onset and it was also helpful to make differential diagnosis between CI and hemorrhage stroke in this period.