血脂及高敏C-反应蛋白对急性冠脉综合征患者长期预后的预测价值

目的评价血脂及高敏C反应蛋白（hs-CRP）对急性冠脉综合征（ACS）患者长期预后的预测价值，探索ACS患者危险分层简便、实用的方法。方法连续入选ACS患者246名，测定其基线水平的hs-CRP、肌钙蛋白T（cTnT）、血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）等指标。观察住院及随访期间主要心血管事件（包括心源性死亡、再发非致命性心肌梗死和因严重心绞痛而再次入院）的发生情况，据此将患者分为事件组和对照组；筛选可独立预测终点事件的指标，并评价其单独及联合预测价值。所有资料均采用SPSS13．0软件进行分析。结果完成随访241例，其中121例发生心血管事件。事件组和对照组患者的年龄、白细胞计数、hs-CRP、LDL-C／HDL-C和cTnT阳性率均有显著差异（P〈0．05），行Logistic回归分析后只有TC／HDL-C和hs-CRP进入回归方程（P〈0．01）。根据TC／HDL-C和hs-CRP的三分位数对患者进行危险分层，发现随着TC/HDL-C和hs-CRP的升高，患者的心血管事件发生率均呈上升趋势，二者均位于最高三分位数区间的患者的终点事件发生率最高（78．1％）。结论TC／HDL-C和hs-CRP均可以独立预测ACS患者长期再发心血管事件的危险；TC／HDL-C和hs-CRP联合应用的分层效果更佳，hs-CRP可以对经传统血脂所确定的“低危”患者进一步分层，筛选出心血管事件发生率相对较高者。     

Short-term prognostic value of serum neuron specific enolase and S100B in acute stroke patients

ObjectiveTo explore the value of blood markers for brain injury as outcome predictors in acute stroke.Design and methodsThe study included 61 patients with acute stroke (44 ischemic and 17 hemorrhagic) and a high risk control group (79 individuals with no known history of neurological disease).Serum neuron specific enolase (NSE) and S100B were determined by immunoassay (CanAg Diagnostics, Sweden). Outcome at 60 days was evaluated with clinical scales.ResultsHigher concentrations of NSE and S100B were measured in patients compared to high risk controls, but they were not related to stroke severity on admission. NSE was associated with functional neurological outcome at 60 days and to the degree of recovery, whereas S100B exhibited a strong correlation with depression symptoms at 60 days.ConclusionsThe measurements of serum concentrations of NSE and S100B after acute stroke may be clinically relevant for predicting functional neurological outcome and post-stroke depression, respectively.     

急性脑卒中患者超敏C反应蛋白动态变化

目的：探讨超敏C反应蛋白动态变化与急性脑卒中患者临床转归的关系。方法：急性脑卒中患者157例按预后分为存活组（128例）与死亡组（29例）,按病因分为脑梗死组113例和脑出血组44例。比较各组患者发病第1、7、14、21天的血压、神经功能评分、实验室检查及超敏C反应蛋白变化。结果：脑卒中患者发病第1天超敏C反应蛋白明显增加,存活组患者随着病情好转,血压下降、神经功能评分改善,超敏C反应蛋白逐渐下降;死亡组患者超敏C反应蛋白随神经功能评分恶化呈上升趋势,2组比较差异有统计学意义（P〈0．05）。脑梗死组和脑出血组患者血压、神经功能评分、常规生化检查及超敏C反应蛋白变化差异无统计学意义（P〉0．05）。结论：动态观察超敏C反应蛋白变化,有助于判断急性脑卒中患者的临床转归和预后。     

灯盏花素治疗急性脑梗死对超敏C反应蛋白的影响及疗效机制

目的 探讨灯盏花素治疗急性脑梗死对超敏C反应蛋白(hsCRP)的影响及疗效机制.方法 采用酶联免疫吸附法(ELLSA法)分别在第2、7、14天检测治疗组、对照组、健康对照组血清hsCRP水平.观察并记录病例治疗前及治疗后第7、14、30天的神经功能评分.结果 急性脑梗死患者血清hsCRP水平较健康对照组明显增高,血清hsCRP水平与神经功能缺损程度呈正相关;治疗组血清hsCRP水平在治疗后第7、14天较对照组明显降低(P＜0.05),神经功能评分在治疗后第7、14、30天时与对照组比较差异有统计学意义(P＜0.05,P＜0.01);治疗组未见明显不良反应.结论 血清hsCRP水平与脑梗死及病情严重程度密切相关,是脑梗死的危险因素.灯盏花素治疗急性脑梗死时可降低hsCRP水平,抑制急性脑梗死后的血管炎性反应,减轻神经功能障碍,改善脑梗死患者预后.灯盏花素治疗急性脑梗死具有一定的疗效及安全性.     

血清脂肪酸结合蛋白、超敏C反应蛋白与急性缺血性脑卒中的相关性

目的研究血清脂肪细胞脂肪酸结合蛋白(A-FABP)、超敏C反应蛋白(hs-CRP)在急性缺血性脑卒中(AIS)中的变化及其相关性。方法选取2011年7月至2013年6月该院收治的AIS患者116例为研究对象,采用双抗体夹心酶联免疫吸附法(DAS-ELISA),测定不同血清A-FABP、hs-CRP水平。选取同期体检中心80例体检健康者作为对照组。采用改良Rankin评分(mRS),将患者神经功能缺损程度分为轻症组(mRS≤3分)和重症组(mRS3分),分析两组间A-FABP、hs-CRP水平并进行hs-CRP与A-FABP之间的直线相关和回归分析。结果 AIS患者hs-CRP、A-FABP水平明显高于对照组。神经功能缺损程度越重,缺血性脑卒中患者血清中hs-CRP、A-FABP水平越高。直线与相关回归分析表明hs-CRP、A-FABP呈正相关。结论血清hs-CRP、A-FABP水平升高与AIS程度相关,hs-CRP、A-FABP可能参与AIS发生、发展。     

超敏C反应蛋白水平与急性脑梗死患者颈动脉粥样硬化斑块的相关性研究

目的 探讨血清超敏C反应蛋白(hsCRP)水平与急性脑梗死患者颈动脉粥样斑块的关系.方法 对126例急性脑梗死患者(脑梗死组)及119例健康体检者(对照组)进行研究,采用全自动生化分析仪检测血清中超敏C反应蛋白水平,应用彩超检测颈动脉内-中膜厚度(IMT)及斑块位置、数目及类型.结果 脑梗死组超敏C反应蛋白水平、颈动脉内-中膜厚度、斑块检出率均显著高于对照组,差异有统计学意义(P＜0.05);脑梗死组颈动脉斑块检出数目及性质和对照组比较,差异有统计学意义(P＜0.05).结论 hsCRP与脑梗死患者颈动脉粥样硬化斑块形成及稳定性密切相关.     

Clinical value of serum JKAP in acute ischemic stroke patients

BackgroundJun N‐terminal kinase pathway‐associated phosphatase (JKAP) regulates neuronal function, T helper (Th) 1/2/17 cell differentiation, and inflammatory process, but its clinical role in acute ischemic stroke (AIS) patients remains unclear. Hence, this study intended to evaluate JKAP level and its relationship with disease severity, Th1, 2, 17 secreted cytokines, adhesion molecules, and prognosis of AIS patients.MethodsSerum JKAP of 122 AIS patients and 50 controls was detected by ELISA. For AIS patients only, Th1, 2, 17 secreted cytokines IFN‐γ, IL‐4, IL‐17; TNF‐α, ICAM‐1, and VCAM‐1 were also detected by ELISA.ResultsJKAP was decreased in AIS patients compared with controls (46.350 (interquartile range (IQR): 34.250–59.875) pg/ml vs. 84.500 (IQR: 63.175–113.275) pg/ml, p < 0.001), which could distinguish AIS patients from controls (area under curve (AUC): 0.810, 95% confidence interval (CI): 0.732–0.888). In AIS patients, JKAP negatively linked with the National Institutes of Health Stroke Scale (NIHSS) score (r_s  = −0.342, p < 0.001); besides, it was positively related to IL‐4 (r_s  = 0.213, p = 0.018) and negatively associated with IL‐17 (r_s  = −0.270, p = 0.003) but not related to IFN‐γ (r_s  = −0.146, p = 0.109). Furthermore, elevated JKAP associated with declined TNF‐α (r_s  = −0.219, p = 0.015) and ICAM‐1 (r_s  = −0.235, p = 0.009) but not related to VCAM‐1 (r_s  = −0.156, p = 0.085). Besides, declined JKAP was linked with 2‐year recurrence (p = 0.027) and 3‐year recurrence (p = 0.010) in AIS patients; while JKAP was not related to 1‐year recurrence or death risk (both p > 0.050).ConclusionJKAP may sever as a candidate prognostic biomarker in AIS patients, indicating its potency for AIS management.     

Evaluation of pregnancy-associated plasma protein A as a prognostic indicator in acute coronary syndrome patients

BACKGROUND: Higher circulating concentrations of pregnancy-associated plasma protein A (PAPP-A), a potential proatherosclerotic metalloproteinase, have been associated with increased risk for acute coronary syndrome (ACS). Our goal was to determine the ability of circulating concentrations of PAPP-A to predict adverse events in patients presenting to the Emergency Department (ED) with symptoms of ACS. METHODS: A total of 346 patients with symptoms of ACS were included in the study. Serum samples obtained immediately after enrollment were analyzed for PAPP-A and cardiac troponin T (cTnT). The occurrence of adverse events during a 30-day follow-up period was recorded, and receiver-operating characteristic (ROC) curve analysis was performed to evaluate the prognostic characteristics of PAPP-A and cTnT. RESULTS: A total of 33 (9.5 %) patients developed adverse events during the follow up period. At a cut-off concentration of 0.22 mIU/l, PAPP-A was a predictor of adverse events with a sensitivity and specificity (95% C.I.) of 66.7% (48.2-82.0) and 51.1% (45.4-56.8), respectively. The sensitivity and specificity of cTnT were 51.5% (33.6-69.2) and 82.1% (77.4-86.2), respectively, using a 0.01-ng/ml cut-off value, which was obtained using ROC analysis. CONCLUSIONS: PAPP-A appears to be a modest predictor of adverse events in patients presenting to the ED with ACS symptoms, being inferior to cTnT in predicting adverse events in an ED setting. PAPP-A appears to be as sensitive as cTnT, but it is less specific.     

急性冠状动脉综合征患者血清PAPP-A、hs-CRP水平变化及临床意义

目的探讨急性冠状动脉综合征（ACS）患者血清妊娠相关血浆蛋白A（PAPP—A）、高敏C反应蛋白（hs—CRP）的变化及临床意义。方法采用时间分辨免疫荧光分析法检测30例急性心肌梗死（AMI）患者、21例不稳定心绞痛（UAP）患者、25例稳定性心绞痛（SAP）患者和20名正常对照者血清PAPP—A,同时用乳胶增强比浊法检测血清hs—CRP。结果SAP组血清PAPP—A水平与正常对照组比较无差异（P〉0．05）;UAP组和AMI组血清PAPP—A水平均明显高于正常对照组和SAP组（P均〈0．01）,但UAP组血清PAPP—A水平与AMI组比较无差异。SAP组血清hs—CRP水平明显高于正常对照组（P〈0．05）;UAP组明显高于正常对照组和SAP组（P〈0．01）,但低于AMI组（P〈0．01）。ACS组血清PAPP—A水平与血清hs—CRP水平呈正相关（r=0．53,P〈0．01）。结论ACS患者血清PAPP—A与hs—CRP水平均明显升高,且hs—CRP与PAPP—A之问存在明显相关性。PAPP—A水平升高可能与动脉粥样硬化斑块的不稳定性有关,提示可作为识别ACS的早期血清学标志物。     

急性冠状动脉综合征患者血清PAPP-A、hs-CRP水平变化及临床意义

目的探讨急性冠状动脉综合征(ACS)患者血清妊娠相关血浆蛋白A(PAPP-A)、高敏C反应蛋白(hs-CRP)的变化及临床意义。方法采用时间分辨免疫荧光分析法检测30例急性心肌梗死(AMI)患者、21例不稳定心绞痛(UAP)患者、25例稳定性心绞痛(SAP)患者和20名正常对照者血清PAPP-A,同时用乳胶增强比浊法检测血清hs-CRP。结果SAP组血清PAPP-A水平与正常对照组比较无差异(P>0.05);UAP组和AMI组血清PAPP-A水平均明显高于正常对照组和SAP组(P均<0.01),但UAP组血清PAPP-A水平与AMI组比较无差异。SAP组血清hs-CRP水平明显高于正常对照组(P<0.05);UAP组明显高于正常对照组和SAP组(P<0.01),但低于AMI组(P<0.01)。ACS组血清PAPP-A水平与血清hs-CRP水平呈正相关(r=0.53,P<0.01)。结论ACS患者血清PAPP-A与hs-CRP水平均明显升高,且hs-CRP与PAPP-A之间存在明显相关性。PAPP-A水平升高可能与动脉粥样硬化斑块的不稳定性有关,提示可作为识别ACS的早期血清学标志物。     

急性冠状动脉综合征妊娠相关血浆蛋白-A与C-反应蛋白、肿瘤坏死因子-α相关性的探讨

目的研究急性冠状动脉综合征(ACS)患者血清妊娠相关血浆蛋白A(PAPP-A)的变化及其与血清高敏C-反应蛋白(hsCRP)和肿瘤坏死因子-α(TNF-α)水平的相关性。方法测定18例不稳定型心绞痛(UAP组)、37例急性心肌梗死(AMI组)和15例稳定型心绞痛(SAP组)及15例正常对照者的血清PAPP-A、hsCRP、TNF-α水平。结果SAP组血清PAPP-A水平与正常对照组相比,差异无显著性(P>0.05);UAP组和AMI组血清PAPP-A水平均显著高于正常对照组(P<0.01)和SAP组(P<0.01),但UAP组与AMI组相比,差异无显著性。cTnT阴性ACS组患者血清PAPP-A水平也明显高于正常对照组(P<0.01)和SAP组(P<0.05)。SAP组血清hsCRP和TNF-α水平明显高于正常对照组;UAP组明显高于正常对照组和SAP组,但低于AMI组。单因素直线相关分析显示,ACS组患者的血清PAPP-A水平与hsCRP和TNF-α水平呈显著正相关(r=0.616、0.712,P<0.01)。结论PAPP-A与炎症密切相关,在识别没有cT-nT升高的ACS患者方面有重要临床应用价值。     

3项联合检测对感染性慢性阻塞性肺病急性发作期的临床价值

目的探讨联合血清降钙素原（PCT）和超敏C-反应蛋白（hs—CRP）及白细胞（WBC）3项指标在感染性慢性阻塞性肺疾病急性发作期（AECOPD）中的临床价值。方法选择83例AECOPD患者,测定他们治疗前后PCT、hs—CRP、WBC,并且进行肺功能测定、肺功能多项参数系统指数计算,分析hs—cRP和PCT水平与感染程度和BODE指数的相关性。结果hs—CRP、PCT、WBC在感染性AECOPD中的表达比其他指标更为灵敏,治疗后变化更明显,差异有统计学意义（P〈0．01）,而且与BODE指数皆呈正相关。结论联合捡测PCT、hs—CRP及WBC可作为监测AECOPD炎性反应状况及其控制情况的敏感性指标,可提示病情的严重程度及预后情况。     

急性冠脉综合征患者血浆胱抑素C和超敏C反应蛋白检测的临床意义

目的 探讨检测急性冠脉综合征(ACS)患者血浆胱抑素C(CysC)和超敏C反应蛋白(hs-CRP)水平的临床意义.方法 选择108例ACS患者[急性心肌梗死(AMI)52例(AMI组),不稳定性心绞痛(UA)56例(UA组)]和54例稳定性心绞痛(SA)患者(SA组)及52例健康体检者(对照组),用乳胶增强免疫透射比浊法检测血浆CysC和hs-CRP,同时检测血清肌酐、血尿素氮等.结果 AMI组、UA组、SA组血浆CysC水平均高于对照组,肾小球滤过率(GFR)均低于对照组,AMI组、UA组血浆CysC 、hs-CRP水平均高于SA组和对照组,多支病变组血浆CysC、hs-CRP水平明显高于单支病变组(P<0.01),CysC与hs-CRP呈直线正相关(r=0.77,P<0.01).结论 血浆CysC水平能早期反映ACS患者肾功能改变,与血浆hs-CRP水平一样是反映ACS炎症程度的重要指标.     

进展性脑梗死患者血浆中D-二聚体、纤维蛋白原和血清超敏C-反应蛋白的变化及相关分析

目的测定进展性脑梗死患者血浆中D-二聚体（D-D）、纤维蛋白原和超敏C-反应蛋白（hs-CRP）水平及探讨其临床相关性。方法选择2005年5月~2011年8月本院住院的进展性脑梗死患者及同期住院的非进展性脑梗死患者各50例,以同期健康体检者50例为对照组,分别测定各自血浆中D-D、纤维蛋白原和血清hs-CRP水平,并进行统计学分析。结果进展性脑梗死组患者的hs-CRP、纤维蛋白原和D-D的含量较非进展性脑梗死组患者明显升高（P〈0.01）;非进展性脑梗死组患者hs-CRP、纤维蛋白原和D-D的含量较对照组明显升高（P〈0.01）;进展性脑梗死组患者D-D升高阳性率比非进展性脑梗死组患者高（P〈0.01）;非进展性脑梗死组患者D-D升高阳性率比对照组高（P〈0.05）。结论测定脑梗死患者这3种指标有助于进展性脑梗死的预测及制定相应的干预措施。     

瑞舒伐他汀钙对急性脑梗死患者血脂和血清超敏C反应蛋白的影响

目的：比较瑞舒伐他汀钙和辛伐他汀对急性脑梗死患者血脂的疗效,并对两组患者高敏C‐反应蛋白（hs‐CRP）水平对比分析。方法选取120例脑梗死合并高脂血症的患者,随机分为观察组和对照组各60例。分别予以瑞舒伐他汀钙、辛伐他汀治疗,用药4周后检测血清脂蛋白、hs‐CRP水平。结果观察组较对照组血清低密度脂蛋白、hs‐CRP显著降低（P＜0．05）。结论瑞舒伐他汀钙可降低急性脑梗死患者的血脂及hs‐CRP水平,对急性脑梗死具有较好的疗效。     

血浆S100B蛋白在缺氧缺血性脑病新生儿的诊断评估

目的 探讨血浆S100B蛋白对缺氧缺血性脑病(hypoxic ischemic encephalopathy,HIE)新生儿脑损伤的临床意义.方法 选择54例临床诊断为HIE的新生儿在出生12 h时抽血检测S100B、神经元特异性烯醇化酶(neuron specific enolase,NSE)及脑型肌酸激酶同功酶(creatine kinaes BB isozyme,CK-BB),与47例非HIE的窒息新生儿和22例健康新生儿进行对照比较.评价敏感性和特异性,绘制ROC曲线,计算ROC曲线下面积.结果 出生12 h时HIE患儿血浆S100B、NSE和CK-BB阳性率显著高于窒息组和对照组(均P<0.01),S100B对HIE的敏感性为88.89%,特异性为82.61%,之和高于NSE及CK-BB.S100B的ROC曲线下面积最大(面积:0.950;95%可信区间0.918-0.983),临床诊断效能高于NSE及CK-BB.结论 HIE患儿出生12 h时血浆S100B、NSE和CK-BB均能预示HIE患儿的脑部损伤,S100B阳性率最高,三指标联合检测,有助于HIE的早期诊断和病情判断.     

C-反应蛋白对急性冠脉综合征患者预后判断价值

目的探讨血浆炎症标志物C-反应蛋白水平与急性冠脉综合征(ACS)的相关性以及与近期预后的关系。方法测定120例ACS患者和94例健康对照组的血浆CRP水平,随访ACS患者住院期间、30天以及3个月死亡事件以及MACE发生率。结果(1)120例ACS患者中AMI组35例,UAP组85例,血浆CRP水平分别为17.81±10.4 mg/L和10.64±6.58 mg/L,与对照组CRP水平4.52±1.20 mg/L相比均明显升高,P<0.05,而且AMI组和UAP组之间的CRP水平也有差异,AMI组高于UAP组,P<0.05。(2)根据血浆CRP水平将120例ACS患者分为三组:CRP≤8.0 mg/L组,8.1-24.0 mg/L组,>24.0 mg/L组。随着血浆CRP水平的升高,各组的死亡率和MACE发生率也呈现增高趋势。在多变量的Logistic回归分析中,CPR独立于年龄、性别、吸烟、高脂血症、高血压、糖尿病等冠心病危险因素,预测30天死亡率OR=3.33,95%CI 1.71-12.46,3个月死亡率OR=3.08,95%CI 1.57-10.89,P<0.05;预测30天MACE发生率,OR=1.29,95%CI 1.11-6.01,3个月MACE发生率,OR=1.14,95%CI 1.09-5.27,P<0.05。结论血浆CRP水平与ACS密切相关,ACS病情越严重CRP水平越高。而且CRP水平和ACS患者的临床事件的发生率密切相关,可预测短期的病死率和MACE发生率,对判断ACS患者的近期预后有重要的参考价值。     

妊娠相关血浆蛋白A在急性冠状动脉综合征发病学中的意义

目的 探讨急性冠状动脉综合征(ACS)患者妊娠相关血浆蛋白A的变化及临床意义.方法 入选220例患者,其中冠心病(CHD)组140例[ACS组98例,稳定型心绞痛(SAP)组42例],对照组80例.ELISA法检测患者外周血浆妊娠相关血浆蛋白A浓度.同时经选择性冠状动脉造影检查明确冠状动脉病变情况.结果 ①CHD组妊娠相关血浆蛋白A浓度较对照组升高(P均＜0.05),且ACS组较SAP组升高更明显(P＜0.05);②ACS患者单支、双支、三支病变组妊娠相关血浆蛋白A浓度较对照组升高(P均＜0.05),三支病变组显著高于单支、双支组(P均＜0.05);③ACS患者轻度、中度、重度病变组妊娠相关血浆蛋白A浓度显著高于对照组(P均＜0.05),重度病变组显著高于轻度、中度病变组(P均＜0.05);④Gensini积分与冠心病非传统危险因子多重线性回归分析提示,妊娠相关血浆蛋白A、hs-CRP为冠心病的危险因子.结论 妊娠相关血浆蛋白A为冠心病的危险因子,有望成为新的血清学指标,能尽早反映冠状动脉斑块稳定性.     

The value of serial plasma nuclear and mitochondrial DNA levels in patients with acute ischemic stroke

BackgroundElevated circulating cell-free DNA in plasma is reported in several critical diseases. This study hypothesized that since plasma nuclear and mitochondrial DNA substantially increase after acute ischemic stroke and decrease thereafter, their levels can predict treatment outcomes.MethodsPlasma nuclear and mitochondrial DNA levels were serially examined in 50 acute ischemic stroke patients and in 50 at risk control subjects during the study period.ResultsLevels of plasma nuclear and mitochondrial DNA in patients with acute ischemic stroke were significantly higher than those in the controls (p < 0.05). Elevated circulating nuclear DNA in plasma persisted until one month after the acute stroke. Levels of plasma nuclear DNA positively correlated to the clinical severity of stroke as reflected by the National Institutes of Health Stroke Scale.ConclusionLevels of plasma nuclear and mitochondrial DNA reflect the severity of cerebral damage after acute cerebral infarction. Assay of plasma DNA levels can be considered a neuro-pathologic marker of patients with acute ischemic stroke.