急性脑梗死患者血清r-谷氨酰转移酶水平与病因学分型、病情严重程度的关系
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摘要
目的探讨脑梗死患者血清r-谷氨酰转移酶(r-GT)水平的变化及其临床意义。方法收集126例脑梗死患者,采用ELISA法测定r-GT、血糖、血脂水平,进行TOAST病因学分型,对患者入院时行NIHSS评分,<8分定义为轻度脑梗死,≥8分定义为中重度脑梗死,选取130例同期门诊体检健康者作为对照组,收集r-GT水平,比较脑梗死组和对照组r-GT水平的差异及大动脉粥样硬化组和小动脉闭塞组r-GT水平的差异,进一步分析r-GT水平和脑梗死严重程度的相关性。结果脑梗死组r-GT水平明显高于对照组(P<0.01)。大动脉粥样硬化组r-GT水平高于小动脉闭塞组(P<0.05),而2组间其他动脉粥样硬化相关危险因素无明显差异(P>0.05)。中重度脑梗死组r-GT水平明显高于轻度脑梗死组(P<0.01),多变量logistic回归分析显示,血清r-GT[比值比(OR)1.058,95%可信区间(CI)1.001～1.118,P<0.05]水平升高与脑梗死病情严重程度存在独立相关性。结论急性脑梗死患者r-GT水平明显升高,作为一种氧化应激指标,可帮助区别大动脉粥样硬化性脑梗死和小动脉闭塞性脑梗死,且r-GT水平与神经功能缺损程度存在显著相关性。
Objective To investigate the changes of serum gamma-glutamyl transferase(r-GT)level and its clinical significance in patients with acute cerebral infarction.Methods A total of 126 patients with acute cerebral infarction were recruited for the study,the levels of r-GT、blood sugar、blood lipid were measured with ELISA.All the patients were classified based on TOAST criteria.The National Institutes of Health Stroke Scale(NIHSS)was used on the day of admission.The NIHSS score<8 was defined as mild stroke and The NIHSS score≥8 was defined as moderate to severe stroke.130 healthy subjects in the outpatient clinic at the same time were used as a control group and the levels of r-GT were also measured.The difference of serum rGT level was investigated between stroke patients and control subjects,also between large artery atherosclerosis group and small artery occlusion group.The correlations of serum r-GT level with severity in patients with acute cerebral infarction were further explored.Results The r-GT levels in stoke patients were significantly higher than those in control subjects(P<0.01).The r-GT levels in patients of large artery atherosclerosis group were higher than those in small artery occlusion group(P<0.05),and there were no statistical difference for other risk factors on atherosclerosis in the two groups.The r-GT levels in the moderate to severe stroke group were significantly higher than those in the mild stroke group(P<0.01),Multivariate logistic regression analysis showed that the increased levels of serum r-GT [odds ratio(OR)1.058,95% confidence interval(CI)1.001-1.118,P<0.05]had independent correlation with the severity of stroke patients.Conclusion The serum r-GT levels were significantly increased in patients with acute cerebral infarction.As an indicator of oxidative stress,it was helpful for serum r-GT to distinguish large artery atherosclerosis stroke from small artery occlusion stroke.Furthermore,there were significant correlations for serum r-GT level with the degree of neurological impairment in patients with acute cerebral infarction.
Objective To investigate the changes of serum gamma-glutamyl transferase(r-GT)level and its clinical significance in patients with acute cerebral infarction.Methods A total of 126 patients with acute cerebral infarction were recruited for the study,the levels of r-GT、blood sugar、blood lipid were measured with ELISA.All the patients were classified based on TOAST criteria.The National Institutes of Health Stroke Scale(NIHSS)was used on the day of admission.The NIHSS score<8 was defined as mild stroke and The NIHSS score≥8 was defined as moderate to severe stroke.130 healthy subjects in the outpatient clinic at the same time were used as a control group and the levels of r-GT were also measured.The difference of serum rGT level was investigated between stroke patients and control subjects,also between large artery atherosclerosis group and small artery occlusion group.The correlations of serum r-GT level with severity in patients with acute cerebral infarction were further explored.Results The r-GT levels in stoke patients were significantly higher than those in control subjects(P<0.01).The r-GT levels in patients of large artery atherosclerosis group were higher than those in small artery occlusion group(P<0.05),and there were no statistical difference for other risk factors on atherosclerosis in the two groups.The r-GT levels in the moderate to severe stroke group were significantly higher than those in the mild stroke group(P<0.01),Multivariate logistic regression analysis showed that the increased levels of serum r-GT [odds ratio(OR)1.058,95% confidence interval(CI)1.001-1.118,P<0.05]had independent correlation with the severity of stroke patients.Conclusion The serum r-GT levels were significantly increased in patients with acute cerebral infarction.As an indicator of oxidative stress,it was helpful for serum r-GT to distinguish large artery atherosclerosis stroke from small artery occlusion stroke.Furthermore,there were significant correlations for serum r-GT level with the degree of neurological impairment in patients with acute cerebral infarction.
引文
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[9]代瑞宁,刘洋,傅佳.脑梗死患者r-谷氨酰转肽酶与颅内外动脉狭窄的相关性[J].中国动脉硬化杂志,2015,23(1):69-72.
[10]Park JS,Kang S,Yoo JS,et al.Association between gammaglutamyl transferase,adiponectin and arterial stiffness[J].J Atheroscler Thromb,2012,19(1):90-97.
[11]刘晓楠,董玉霞,姜源,等.r-谷氨酰转移酶水平与急性脑梗死CISS病因分型的相关性研究[J].中国医科大学学报,2014,43(12):1096-1099.
[12]Emine A,Dogan NO,Gumus H,et al.Can we use serum gamma-glutamyl transferase levels to predict early mortality in stroke?[J].Pak J Med Sci,2014,30(3):606-610.
[13]Tu WJ,Liu Q,Cao JL,et al.R-glutamyl transferase as a risk factor for all-cause or cardiovascular disease mortality among5912ischemic stroke[J].Stroke,2017,48(10):2888-2891.
[14]贾瑛,穆红.血清r-谷氨酰转移酶和胆红素检测在急性脑梗死患者中的意义[J].广东医学,2014,35(10):1580-1581.
[15]Korantzopoulos P,Tzimas P,Kalantzi K,et al.Association between serum r-glutamyl transferase and acute ischemic nonembolic stroke in elderly subjects[J].Arc Med Res,2009,40(7):582-589.
[16]Sarli B,Baktir AO,Saglam H,et al.The relation of serum gamma-glutamyl transferase levels and coronary collateral circulation in patients with chronic coronary total occlusion[J].Coron Artery Dis,2013,24(4):298-302.
[2] Ndrepepa G,Kastrati A.Gamma-glutamyl transferase and cardiovascular disease[J].Ann Transl Med,2016,4(24):481-495.
[3] Weikert C,Drogan D,Di Giuseppe RA,et al.Liver enzymes and stroke risk in middle-aged German adults[J].Atherosclerosis,2013,228(2):508-514.
[4]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[5]王拥军.氧化应激与缺血性脑血管病[J].中国卒中杂志,2008,3(3):163-165.
[6] Eroglu S,Sade LE,Polat E.Association between serum gamma-glutamyl transferase activity and carotid intima-media thickness[J].Angiology,2011,62(2):107-110.
[7] Grundy SM.Gamma-glutamyl transferase-Another biomarker for metabolic syndrome and cardiovascular risk[J].Arterioscler Thromb Vasc Biol,2007,27(1):4-7.
[8] Zhang XW,Li M,Hou WS,et al.Association between GammaGlutamyltransferase Level and Risk of Stroke:A Systematic Review and Meta-analysis of Prospective Studies[J].J Stroke Cerebrovasc Dis,2015,24(12):2816-2823.
[9]代瑞宁,刘洋,傅佳.脑梗死患者r-谷氨酰转肽酶与颅内外动脉狭窄的相关性[J].中国动脉硬化杂志,2015,23(1):69-72.
[10]Park JS,Kang S,Yoo JS,et al.Association between gammaglutamyl transferase,adiponectin and arterial stiffness[J].J Atheroscler Thromb,2012,19(1):90-97.
[11]刘晓楠,董玉霞,姜源,等.r-谷氨酰转移酶水平与急性脑梗死CISS病因分型的相关性研究[J].中国医科大学学报,2014,43(12):1096-1099.
[12]Emine A,Dogan NO,Gumus H,et al.Can we use serum gamma-glutamyl transferase levels to predict early mortality in stroke?[J].Pak J Med Sci,2014,30(3):606-610.
[13]Tu WJ,Liu Q,Cao JL,et al.R-glutamyl transferase as a risk factor for all-cause or cardiovascular disease mortality among5912ischemic stroke[J].Stroke,2017,48(10):2888-2891.
[14]贾瑛,穆红.血清r-谷氨酰转移酶和胆红素检测在急性脑梗死患者中的意义[J].广东医学,2014,35(10):1580-1581.
[15]Korantzopoulos P,Tzimas P,Kalantzi K,et al.Association between serum r-glutamyl transferase and acute ischemic nonembolic stroke in elderly subjects[J].Arc Med Res,2009,40(7):582-589.
[16]Sarli B,Baktir AO,Saglam H,et al.The relation of serum gamma-glutamyl transferase levels and coronary collateral circulation in patients with chronic coronary total occlusion[J].Coron Artery Dis,2013,24(4):298-302.