血清VILIP-1、NSE水平与缺血性脑卒中患者预后的关系
摘要
目的探讨血清视锥蛋白样蛋白-1(VILIP-1)、神经元特异性烯醇化酶(NSE)水平与急性缺血性脑卒中患者预后的关系。方法选取109例急性缺血性脑卒中患者作为病例组,采用美国国立卫生研究院卒中量表(NIHSS)评定患者入院时神经功能缺损程度,应用头颅MRI计算脑梗死面积,采用改良的Rankin量表(mRS)评定患者预后情况,并于同期随机选取30例健康体检者为对照组。采用酶联免疫吸附法测定病例组和对照组血清VILIP-1水平,电化学发光法测定血清NSE水平。结果病例组血清VILIP-1、NSE水平高于对照组(P均<0. 001)。神经功能中度缺损、重度缺损者血清VILIP-1、NSE水平高于轻度缺损者(P均<0. 05),且重度缺损者高于中度缺损者(P <0. 05);中等面积脑梗死、大面积脑梗死者血清VILIP-1、NSE水平高于腔隙性梗死者(P均<0. 05),且大面积脑梗死者高于中等面积脑梗死者(P <0. 05)。预后不良者血清VILIP-1、NSE水平高于预后良好者(P均<0. 05)。VILIP-1对急性缺血性脑卒中预后诊断的受试者工作特征曲线(ROC)曲线下面积(AUC)为0. 805,VILIP-1截断值为7. 25μg/L,灵敏度、特异度为0. 85、0. 81,准确度为0. 76; NSE对急性缺血性脑卒中预后诊断的AUC为0. 784,NSE截断值为20. 61 ng/m L,灵敏度、特异度为0. 79、0. 86,准确度为0. 75。结论血清VILIP-1、NSE参与了急性缺血性脑卒中发病过程,且与急性缺血性脑卒中严重程度及预后密切相关,早期联合检测可作为病情判断和预后评估的重要指标。
引文
[1]Baek BH,Kim HS,Yoon W,et al. Inflammatory mediator expression within retrieved clots in acute ischemic stroke[J]. Ann Clin Transl Neurol,2018,5(3):273-279.
[2] Naganuma M,Inatomi Y,Nakajima M,et al. Associations between Uric Acid Level and 3-Month Functional Outcome in Acute Ischemic Stroke Patients Treated with/without Edaravone[J]. Cerebrovasc Dis,2018,45(3-4):115-123.
[3]刘晓丽,张秀芝,蔡军,等. VILIP-1在早期缺血性脑卒中的临床诊断价值[J].中国卫生检验杂志,2014,24(15):2135-2137.
[4]李斌,安中平,朱延霞,等.血清视锥蛋白样蛋白-1及其他因素与缺血性脑卒中后认知障碍的相关性[J].中国慢性病预防与控制,2014,22(6):687-690.
[5]Mroczko B,Groblewska M,Zboch M,et al. Evaluation of visininlike protein 1 concentrations in the cerebrospinal fluid of patients with mild cognitive impairment as a dynamic biomarker of Alzheimer's disease[J]. J Alzheimers Dis,2015,43(3):1031-1037.
[6] Mercier E,Tardif PA,Cameron PA,et al. Prognostic value of neuron-specific enolase(NSE)for prediction of post-concussion symptoms following a mild traumatic brain injury:a systematic review[J]. Brain Inj,2018,32(1):29-40.
[7]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国临床医生,2011,39(3):67-73.
[8]Yaghi S,Herber C,Boehme AK,et al. The Association between Diffusion MRI-Defined Infarct Volume and NIHSS Score in Patients with Minor Acute Stroke[J]. J Neuroimaging,2017,27(4):388-391.
[9]陈欢,卓文燕,朱培培,等. 25-羟基维生素D联合尿酸对缺血性脑卒中严重程度及早期预后的评估价值[J].中国实用神经疾病杂志,2017,20(5):3-7.
[10]Dijkland SA,Voormolen DC,Venema E,et al. Utility-Weighted Modified Rankin Scale as Primary Outcome in Stroke Trials:A Simulation Study[J]. Stroke,2018,49(4):965-971.
[11]方敏,陈治军,武栋成.肝细胞移植治疗缺血性脑卒中的研究进展[J].卒中与神经疾病,2012,19(2):123-127.
[12] Hand PJ,Wardlaw JM,Rowat AM,et al. Magnetic resonance brain imaging in patients with acute stroke:feasibility and patient related difficulties[J]. J Neurol Neurosurg Psychiatry,2005,76(11):1525-1527.
[13]Tarawneh R,D'Angelo G,Macy E,et al. Visinin-like protein-1:diagnostic and prognostic biomarker in Alzheimer disease[J]. Ann Neurol,2011,70(2):274-285.
[14]Groblewska M,Muszynski P,Wojtulewska Supron A,et al. The role of visinin-like protein-1 in the pathophysiology of Alzheimer's disease[J]. J Alzheimers Dis,2015,47(1):17-32.
[15]Kirkwood CM,Mac Donald ML,Schempf TA,et al. Altered Levels of Visinin-Like Protein 1 Correspond to Regional Neuronal Loss in Alzheimer Disease and Frontotemporal Lobar Degeneration[J]. J Neuropathol Exp Neurol,2016,75(2):175-182.
[2] Naganuma M,Inatomi Y,Nakajima M,et al. Associations between Uric Acid Level and 3-Month Functional Outcome in Acute Ischemic Stroke Patients Treated with/without Edaravone[J]. Cerebrovasc Dis,2018,45(3-4):115-123.
[3]刘晓丽,张秀芝,蔡军,等. VILIP-1在早期缺血性脑卒中的临床诊断价值[J].中国卫生检验杂志,2014,24(15):2135-2137.
[4]李斌,安中平,朱延霞,等.血清视锥蛋白样蛋白-1及其他因素与缺血性脑卒中后认知障碍的相关性[J].中国慢性病预防与控制,2014,22(6):687-690.
[5]Mroczko B,Groblewska M,Zboch M,et al. Evaluation of visininlike protein 1 concentrations in the cerebrospinal fluid of patients with mild cognitive impairment as a dynamic biomarker of Alzheimer's disease[J]. J Alzheimers Dis,2015,43(3):1031-1037.
[6] Mercier E,Tardif PA,Cameron PA,et al. Prognostic value of neuron-specific enolase(NSE)for prediction of post-concussion symptoms following a mild traumatic brain injury:a systematic review[J]. Brain Inj,2018,32(1):29-40.
[7]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国临床医生,2011,39(3):67-73.
[8]Yaghi S,Herber C,Boehme AK,et al. The Association between Diffusion MRI-Defined Infarct Volume and NIHSS Score in Patients with Minor Acute Stroke[J]. J Neuroimaging,2017,27(4):388-391.
[9]陈欢,卓文燕,朱培培,等. 25-羟基维生素D联合尿酸对缺血性脑卒中严重程度及早期预后的评估价值[J].中国实用神经疾病杂志,2017,20(5):3-7.
[10]Dijkland SA,Voormolen DC,Venema E,et al. Utility-Weighted Modified Rankin Scale as Primary Outcome in Stroke Trials:A Simulation Study[J]. Stroke,2018,49(4):965-971.
[11]方敏,陈治军,武栋成.肝细胞移植治疗缺血性脑卒中的研究进展[J].卒中与神经疾病,2012,19(2):123-127.
[12] Hand PJ,Wardlaw JM,Rowat AM,et al. Magnetic resonance brain imaging in patients with acute stroke:feasibility and patient related difficulties[J]. J Neurol Neurosurg Psychiatry,2005,76(11):1525-1527.
[13]Tarawneh R,D'Angelo G,Macy E,et al. Visinin-like protein-1:diagnostic and prognostic biomarker in Alzheimer disease[J]. Ann Neurol,2011,70(2):274-285.
[14]Groblewska M,Muszynski P,Wojtulewska Supron A,et al. The role of visinin-like protein-1 in the pathophysiology of Alzheimer's disease[J]. J Alzheimers Dis,2015,47(1):17-32.
[15]Kirkwood CM,Mac Donald ML,Schempf TA,et al. Altered Levels of Visinin-Like Protein 1 Correspond to Regional Neuronal Loss in Alzheimer Disease and Frontotemporal Lobar Degeneration[J]. J Neuropathol Exp Neurol,2016,75(2):175-182.