蛋白质Z与动脉粥样硬化性脑梗死的相关性

目的 观察蛋白质Z（Protein Z,PZ）在动脉粥样硬化性脑梗死（Atherosclerotic cerebral infarction,ACI）患者急性期内的变化,分析PZ与D-二聚体（DD）、纤维蛋白原（FIB）在ACI患者中变化的相关性及血浆PZ的检测在ACI患者中的诊断价值及临床意义.方法 病例组选择发病在72h之内的ACI患者;对照组来自本院健康体检者.所有受检者均于入院即时及入院第14天抽取静脉血测定PZ和相关血凝因素等资料.另采用头颅CT或MRI测量与症状和体征相对应的最大低密度影面积,以及美国国立卫生研究院卒中量表（NIHSS）进行神经功能缺损评分.结果 ACI患者发病3d内血浆PZ、DD、FIB水平明显高于对照组;入院第14天所测的PZ、DD明显高于入院即时所测水平;在诊断ACI的过程中PZ的曲线下面积（AUC）、灵敏度和特异度均高于其他凝血因素,ACI患者血浆PZ浓度与梗死面积及NIHSS评分无相关性.结论 本研究证实了ACI急性期患者体内存在凝血-纤溶系统异常;PZ是脑梗死的一个的危险因素;通过对ACI急性期患者血浆PZ水平及其他血凝因素的检测,结合临床症状、体征及影像学检查,有助于对ACI的诊断和对病情作出判断.

Plasma levels of PZ in atherosclerotic cerebral infarction

Objective By detecting the plasma levels of PZ in acute atherosclerotic cerebral infarction （ACI） to observe the concentrations changes of plasma PZ; to analyze whether there were some relationships among the levels of PZ/D--dimer（DD）/ Fibrinogen（FIB） in ACI, and the diagnostic value and clinical meaning of PZ in ACI. Methods The patients within 72 hours after ACI were included in the experimental group; the cases of control group were healthy examination people at the period time. All people in the study were measured plasma PZ and some coagulation factors on admission and in the 14tb day. Cranium CT/MRI were carried out in order to calculate the biggest infarction size, and according to the National Institute of Health Stroke Scale （NIHSS score） to assess the degree of neurological impairment. All measured values were analyzed by the SPSS 13.0 software. Results The levels of PZ/DD/FIB in the first 72 hours after ACI were obviously higher than the control group; The levels of PZ/DD in the 14th day were obviously higher than the levels of its in the first 72 hours after ACI; The area under the ROC curve/sensitivity/specificity of PZ were all better than the other coagulation factors during of diag- nosing ACI; The plasma levels of PZ has no statistical correlated with the infarction size and NIHSS score in patients after ACI. Conclusions Our data suggested there were some abnormalities in coagulation and fibrinolytie system in patients with ACI; PZ is a independent risk factor; Detecting the plasma levels of PZ and the other coagulative factors in patients after ACI are useful for the diagnosis and judgment of prognosis in these patients.