ApoA1、CRP在肺癌合并腔隙性脑梗死评估中的应用价值

目的 分析载脂蛋白A1（apolipoprotein A1，ApoA1）、C反应蛋白（C-reactive protein，CRP）在肺癌合并腔隙性脑梗死（lacunar infarction，LI）患者病情评估中的应用价值。方法 选取2019年1月至2022年1月于浙江省荣军医院住院治疗的90例肺癌患者，根据是否合并LI进行分组，将单纯肺癌患者纳入对照组（n=62），肺癌合并LI患者纳入观察组（n=28）；选取同期本院体检中心60名健康体检者纳入健康组。比较三组受试者的血清ApoA1、CRP。比较观察组中不同认知功能障碍和神经功能缺损患者的血清ApoA1、CRP，分析血清ApoA1、CRP与简易精神状态检查量表（mini-mental state examination，MMSE）评分、美国国立卫生研究院卒中量表（National Institutes of Health stroke scale，NIHSS）评分的相关性。绘制受试者操作特征曲线分析ApoA1、CRP联合检测对肺癌合并LI的预测价值。结果 观察组患者的血清ApoA1显著低于对照组和健康组，血清CRP显著高于对照组和健康组（P<0.05）；且重度认知功能障碍患者的血清ApoA1显著低于认知功能正常患者和轻度认知功能障碍患者，血清CRP高于认知功能正常患者和轻度认知功能障碍患者（P<0.05）。重度神经功能缺损患者的血清ApoA1显著低于轻度神经功能缺损患者和中度神经功能缺损患者，血清CRP显著高于轻度神经功能缺损患者和中度神经功能缺损患者（P<0.05）。ApoA1与MMSE评分呈正相关，与NIHSS评分呈负相关（P<0.05），CRP与MMSE评分呈负相关，与NIHSS评分呈正相关（P<0.05）。ApoA1联合CRP诊断肺癌合并LI的曲线下面积为0.785（95%CI：0.712~0.967），敏感度、特异性分别为89.28%、87.34%。结论 肺癌合并LI患者的血清ApoA1、CRP异常表达与认知功能、神经功能受损程度存在一定的相关性，ApoA1联合CRP检测可提高肺癌合并LI诊断的敏感度和特异性。

Application value of apolipoprotein A1 and C-reactive protein in the evaluation of lung cancer patients complicated with lacunar infarction

Objective To analyze the application value of apolipoprotein A1 (ApoA1) and C-reactive protein (CRP) in the evaluation of lung cancer patients complicated with lacunar infarction (LI). Methods A total of 90 patients with lung cancer hospitalized in Zhejiang Province Rongjun Hospital from January 2019 to January 2022 were selected. According to whether they were complicated with LI, patients with simple lung cancer were included in control group (n=62), patients with lung cancer complicated with LI were included in observation group (n=28), and 60 healthy physical examination subjects from the physical examination center of our hospital were selected to be included in health group during the same period. The serum ApoA1 and CRP of three groups were compared. The serum ApoA1 and CRP levels of patients with cognitive disorder and neurological impairment were compared in observation group. The correlation of serum ApoA1 and CRP with mini-mental state examination (MMSE) score and National Institutes of Health stroke scale (NIHSS) score were analyzed. Receiver operating characteristic curve was drawn to analyze the predictive value of ApoA1 and CRP combined detection in lung cancer complicated with LI. Results The serum ApoA1 of observation group was significantly lower than that of control group and healthy group, and serum CRP was significantly higher than that of control group and healthy group (P<0.05). The serum ApoA1 of severe cognitive disorder patients was significantly lower than that of normal cognitive function patients and mild cognitive disorder patients, and the serum CRP was higher than that of normal cognitive function patients and mild cognitive disorder patients (P<0.05). Serum ApoA1 in severe neurologic impairment patients was significantly lower than that in mild neurologic impairment patients and moderate neurologic impairment patients, and serum CRP was significantly higher than that in mild neurologic impairment patients and moderate neurologic impairment patients (P<0.05). ApoA1 was positively correlated with MMSE score and negatively correlated with NIHSS score (P<0.05), CRP was negatively correlated with MMSE score and positively correlated with NIHSS score (P<0.05). The area under the curve of ApoA1 combined with CRP in the diagnosis of lung cancer complicated with LI was 0.785 (95%CI: 0.712-0.967), and the sensitivity and specificity were 89.28% and 87.34%, respectively. Conclusion The abnormal expression of ApoA1 and CRP of patients with lung cancer complicated with LI is correlated with the degree of impairment of cognitive function and nervous function. The detection of ApoA1 combined with CRP can improve the sensitivity and specificity of the diagnosis of lung cancer complicated with LI.