血清LP (a)、LDL-C、Hcy和Cys C与急性脑梗死的相关性及诊断价值的研究

目的探讨急性脑梗死（ACI）病人血清脂蛋白aLP（a）]、低密度脂蛋白胆固醇（LDL-C）、同型半胱氨酸（Hcy）、胱抑素C（Cys C）水平与ACI的相关性及其在ACI诊断中的价值。方法选取ACI病人300例作为病例组，采用美国国立卫生研究院卒中量表（NHISS）进行神经功能评分，并选择同期体检者70名作为对照组。比较2组血清葡萄糖（GLU）、胆固醇（CHOL）、高密度脂蛋白胆固醇（HDL-C）、三酰甘油（TG）、Lp（a）、Hcy、LDL-C、Cys C水平。根据NHISS评分将ACI病人分为轻度组（n=173）、中度组（n=89）和重度组（n=38），比较各组血清LP（a）、LDL-C、Hcy、Cys C水平。通过多元logistic回归构建多因素模型，并对模型绘制ROC曲线评价LP（a）、LDL-C、Hcy、Cys C单独和联合对ACI的诊断价值。结果病例组血清GLU、CHOL、HDL-C、Lp（a）、Hcy、LD-C L、Cys C水平均高于对照组（P < 0.05~P < 0.01），2组TG水平差异无统计学意义（P>0.05）。ACI轻度组、中度组、重度组血清LDL-C、Hcy水平均逐渐升高（P < 0.05）；3组血清LP（a）、Cys C水平差异均无统计学意义（P>0.05）。ROC分析显示，Hcy单独诊断ACI的准确性较高（ROC曲线下面积、灵敏度、特异性、约登指数分别为0.799、81.00%、88.53%、69.53%），血清LP（a）、LDL-C、Hcy及Cys C联合检测诊断ACI的准确性最高（ROC曲线下面积、灵敏度、特异性、约登指数分别为0.841、97.14%、90.63%、87.77%）。结论血清LP（a）、LDL-C、Hcy及Cys C的水平与ACI的发生相关，LDL-C、Hcy与脑梗死的严重程度相关。联合LP（a）、LDL-C、Hcy及Cys C对诊断ACI具有更高的敏感度和特异性，其可能成为早期预测ACI发生的生物学指标。

Study on the correlation of serum levels of LP( a) ,LDL-C,Hcy and Cys C with acute cerebral infarction and their diagnostic value

ObjectiveTo investigate the correlation of serum levels of lipoprotein aLP(a)], low-density lipoprotein cholesterol (LDL-C), homocysteine(Hcy) and cystatin C(Cys C) with acute cerebral infarction(ACI), and their diagnostic value.MethodsThe neurological function scoring in 300 ACI patients(case group) were investigated using NHISS scale, and 70 medical examinees were set as the control group during the same period.The serum levels of glucose(GLU), cholesterol(CHOL), high-density lipoprotein cholesterol(HDL-C), triacylagly cerol(TG), LP(a), LDL-C, Hcy and Cys C were compared between two groups.According to NHISS score, the ACI patients were divided into the mild group(n=173), moderate group(n=89) and severe group(n=38), and the serum levels of LP(a), LDL-C, Hcy and Cys C among three groups were compared.The multi-factor model was established using multivariate logistic regression, and the ROC curve was drawn to evaluate the diagnostic value of alone and combination of LP(a), LDL-C, Hcy and Cys C for ACI.ResultsThe serum levels of GLU, CHOL, HDL-C, LP(a), LDL, Hcy and Cys C in case group were higher than those in control group(P < 0.05 to P < 0.01), and the difference of the level of TG between two groups was not statistically significant(P>0.05).The serum levels of LDL-C and Hcy in ACI mild group, moderate group and severe group gradually increased(P < 0.05);and the differences of the levels of LDL-C and Hcy among three groups was not statistically significant(P>0.05).The results of ROC analysis showed that the Hcy alone in the diagnosis of ACI had high accuracy(the area under ROC curve, sensitivity, specificity and Youden index were 0.799, 81.00%, 88.53% and 69.53%, respectively).The accuracy of combination of serum LP(a), LDL-C, Hcy and Cys C in the diagnosis of ACI was the highest(the area under ROC curve, sensitivity, specificity, Youden index were 0.841, 97.14%; 90.63%, 87.77% and 0.80, respectively).ConclusionsThe serum levels of LP(a), LDL-C, Hcy and Cys C are related to the occurrence and severity of ACI, and the LDL-C and Hcy are associated with the severity of ACI.The combined detection of LDL-C, Hcy and Cys C has a higher sensitivity and specificity for the diagnosis of ACI, which may become an early predictor biological indicating of ACI occurrence.