联合检测血清β_2-MG、CHE、D-D水平在评估急性脑梗死患者预后中的价值
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摘要
目的研究联合检测血清β2-微球蛋白(β_2-MG)、胆碱酯酶(CHE)、交联纤维蛋白降解物D-D水平在评估急性脑梗死患者预后中的价值。方法选取2017年2月至2018年2月期间秦皇岛市第一医院100例脑梗死患者为观察组,另选该院治疗的其他脑病患者和同期体检健康者各100例分别为疾病对照组和健康对照组,检测三组的血清脂肪因子血清β_2-MG、CHE、D-D水平,并绘制受试者工作特征(ROC)曲线,评价三者单独及联合检测对急性脑梗死患者预后价值。结果观察组患者血清β_2-MG、D-D水平显著高于对照组,CHE水平显著低于对照组,差异均有统计学意义(P<0.05);且不同严重程度患者血清β_2-MG、CHE、D-D水平差异显著(P<0.05)。血清β_2-MG、美国国立卫生研究院卒中量表(NIHSS)评分、D-D为急性脑梗死的预后独立危险因素,CHE为急性脑梗死预后良好的保护因素。血清β_2-MG、CHE、D-D单项检测诊断急性脑梗死的特异度比较,差异有统计学意义(P<0.05),β_2-MG+CHE+D-D诊断的灵敏度和特异度显著高于β_2-MG+CHE及DD+CHE,差异有统计学意义(P<0.05)。ROC曲线结果显示,β_2-MG+CHE+D-D联合检测的曲线下面积(AUC)为0.832,显著高于β_2-MG+CHE联合检测的0.792和D-D+CHE联合检测的0.778,差异有统计学意义(P<0.05)。结论联合检测血清β_2-MG、CHE、D-D水平对于脑梗死患者的预后具有良好的预测作用,值得临床推广。
Objective To study the value of combined detection of serum β2-microglobulin(β_2-MG),cholinesterase(CHE),and cross-linked fibrin degradant D-D levels in evaluating the prognosis of patients with acute cerebral infarction.Methods 100 patients with cerebral infarction First Hospital of Qinhuangdao from February 2017 to February 2018 were selected as observation group.Another 100 patients with other encephalopathy and the same physical examination were treated as disease control group and healthy control group.The subjects were tested for serum adipokines serum β_2-MG,CHE,D-D levels,and the receiver operating characteristic(ROC)curve was drawn to evaluate the prognostic value of the three patients alone and in combination for acute cerebral infarction.Results The levels of serum β_2-MG and D-D in the observation group were significantly higher than those in the control group,and the CHE level was significantly lower than that in the control group(P<0.05).The levels of serum β_2-MG,CHE and D-D in patients with different severity were observed.The difference was significant(P<0.05).Serum β_2-MG,National Institutes of Health Stroke Scale(NIHSS)score,D-D were independent prognostic factors for acute cerebral infarction,and CHE was a good prognostic factor for acute cerebral infarction.The specificity of serum β_2-MG,CHE and DD in the diagnosis of acute cerebral infarction was statistically significant(P<0.05).The sensitivity and specificity of β_2-MG+CHE+DD diagnosis were significantly higher than β_2-MG+CHE and D-D+CHE,the difference was statistically significant(P<0.05).The ROC curve showed that the area under the curve(AUC)of β_2-MG+CHE+DD combined detection was 0.832,which was significantly higher than the 0.792 of the combined detection of β_2-MG+CHE and 0.778 of the combined detection of D-D+CHE.Academic significance(P<0.05).Conclusion Combined detection of serum beta_2-MG,CHE and D-D levels has a good predictive effect on the prognosis of patients with cerebral infarction,and is worthy of clinical promotion.
Objective To study the value of combined detection of serum β2-microglobulin(β_2-MG),cholinesterase(CHE),and cross-linked fibrin degradant D-D levels in evaluating the prognosis of patients with acute cerebral infarction.Methods 100 patients with cerebral infarction First Hospital of Qinhuangdao from February 2017 to February 2018 were selected as observation group.Another 100 patients with other encephalopathy and the same physical examination were treated as disease control group and healthy control group.The subjects were tested for serum adipokines serum β_2-MG,CHE,D-D levels,and the receiver operating characteristic(ROC)curve was drawn to evaluate the prognostic value of the three patients alone and in combination for acute cerebral infarction.Results The levels of serum β_2-MG and D-D in the observation group were significantly higher than those in the control group,and the CHE level was significantly lower than that in the control group(P<0.05).The levels of serum β_2-MG,CHE and D-D in patients with different severity were observed.The difference was significant(P<0.05).Serum β_2-MG,National Institutes of Health Stroke Scale(NIHSS)score,D-D were independent prognostic factors for acute cerebral infarction,and CHE was a good prognostic factor for acute cerebral infarction.The specificity of serum β_2-MG,CHE and DD in the diagnosis of acute cerebral infarction was statistically significant(P<0.05).The sensitivity and specificity of β_2-MG+CHE+DD diagnosis were significantly higher than β_2-MG+CHE and D-D+CHE,the difference was statistically significant(P<0.05).The ROC curve showed that the area under the curve(AUC)of β_2-MG+CHE+DD combined detection was 0.832,which was significantly higher than the 0.792 of the combined detection of β_2-MG+CHE and 0.778 of the combined detection of D-D+CHE.Academic significance(P<0.05).Conclusion Combined detection of serum beta_2-MG,CHE and D-D levels has a good predictive effect on the prognosis of patients with cerebral infarction,and is worthy of clinical promotion.
引文
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[12]周发为,杨溢.急性缺血性脑梗死患者缺血修饰清蛋白、超敏C反应蛋白水平及其对预后的价值研究[J].中国全科医学,2016,19(16):1891-1894.
[13]路蔚,陈金来,刘怀翔.亚甲基四氢叶酸还原酶C677T基因突变的脑梗死患者轻度血管性认知功能障碍发病情况研究[J].中华老年医学杂志,2017,36(6):121.
[14]李春瑶,司味鑫,赵越,等.血清胆碱酯酶水平与急性脑梗死病情严重程度及预后的相关性[J].中国医科大学学报,2016,45(5):417-421.
[15]荀顺芹.血浆D-二聚体和纤维蛋白原降解产物检测在急性脑梗死患者中的临床意义[J].中国实用神经疾病杂志,2016,19(14):63-64.
[2]刘洋,代瑞宁,史秀丽,等.急性脑梗死患者血清胱抑素C和β2-微球蛋白水平的临床观察[J].中国动脉硬化杂志,2016,24(4):405-408.
[3]陈鹏杰,赵建军,吕学海,等.补阳还五汤加减对急性脑梗死患者β2-MG和脑水肿情况的影响[J].现代中西医结合杂志,2018,27(4):361-363.
[4]杨玉红,张志民,何大艳,等.初次发病的中青年急性期进展性脑梗死患者血清C反应蛋白、血浆纤维蛋白原、D-二聚体水平研究[J].中国基层医药,2016,23(14):2186-2188.
[5]赵建国,高长玉,顼宝玉,等.脑梗死和脑出血中西医结合诊断标准(试行)[J].中国中西医结合杂志,2006,26(10):948-949.
[6]LYDEN P,RAMAN R,LIU L,et al.NIHSS training and certification using a new digital video disk is reliable[J].Stroke,2005,36(11):2446-2449.
[7]STEPHEN I S,CHRISTUDAS S,ANTONY S,et al.Protective effects of Ficus carica leaves on glucose and lipids levels,carbohydrate metabolism enzymes andβ-cells in type 2diabetic rats[J].Pharm Biol,2017,55(1):1074.
[8]SINDHURAKAR A,MISHRA A M,GUPTA D,et al.Clinically relevant levels of 4-aminopyridine strengthen physiological responses in intact motor circuits in rats,especially after pyramidal tract injury[J].Neur Neural Rep,2017,31(4):387-396.
[9]NATTUDURAI G,BASKAR K,PAULRAJ M G,et al.Toxic effect of Atalantia monophylla essential oil on Callosobruchus maculatus and Sitophilus oryzae[J].Environ Sci Pollut Res Int,2017,24(2):1-11.
[10]KASHANI T,JAHANSHAHI M,RAHIMPOUR A,et al.Nanopore molecularly imprinted polymer membranes for environmental usage:selective separation of 2,4-dichlorophenoxyacetic acid as a toxic herbicide from water[J].J Macromol Sci,2016,55(16):1700-1712.
[11]RAMESH K D,SARAVANA K P,GANDHI M R,et al.Delivery of chitosan/dsRNA nanoparticles for silencing of wing development vestigial(vg)gene in Aedes aegypti mosquitoes[J].Int J Biol Macromol,2016(86):89-95.
[12]周发为,杨溢.急性缺血性脑梗死患者缺血修饰清蛋白、超敏C反应蛋白水平及其对预后的价值研究[J].中国全科医学,2016,19(16):1891-1894.
[13]路蔚,陈金来,刘怀翔.亚甲基四氢叶酸还原酶C677T基因突变的脑梗死患者轻度血管性认知功能障碍发病情况研究[J].中华老年医学杂志,2017,36(6):121.
[14]李春瑶,司味鑫,赵越,等.血清胆碱酯酶水平与急性脑梗死病情严重程度及预后的相关性[J].中国医科大学学报,2016,45(5):417-421.
[15]荀顺芹.血浆D-二聚体和纤维蛋白原降解产物检测在急性脑梗死患者中的临床意义[J].中国实用神经疾病杂志,2016,19(14):63-64.