不同TOAST亚型老年急性脑梗死患者血清髓鞘碱性蛋白水平变化及其临床意义

摘要

目的 观察不同类型老年急性脑梗死(ACI)患者血清髓鞘碱性蛋白(MBP)变化与美国国立卫生研究院卒中量表(NIHSS)评分的关系.方法 采用ELISA法检测328例住院老年ACI患者血清MBP含量,并按照急性卒中治疗低分子肝素试验(TOAST)分型标准分为5大亚型,分析TOAST各亚型血清MBP含量变化及NIHSS评分的相关性.结果 本组TOAST各亚型构成比:大动脉粥样硬化型(LAA)42.99%、小动脉闭塞型(SAO)21.95%、心源性栓塞型(CE)15.85%、不明原因型(SUE)15.55%及其他明确病因型(SDE)3.66%;CE、LAA、SUE血清MBP含量升高,SAO变化不明显,与对照组比较,LAA、CE差异有统计学意义(P<0.01);血清MBP含量与TC、TG、LDL-C、SBP、DBP和年龄呈正相关,与HDL呈负相关;血清MBP含量在LAA、SUE亚型与相应NIHSS评分具有相关性(r=0.68、0.51),在CE、SAO亚型中相关性较差.结论 血清MBP含量随TOAST亚型的不同而变化.LAA、SUE亚型的缺血性卒中患者在发病后血清MBP含量可以作为病情、预后判断的一个参考依据.%Objective To invesligale pallern of flue Lua Lions and clinical significance of myelin basic prolein ( MBP) levels in old palienl wilh different subtypes of acule cerebral infarcl and ils relationship wilh ihe score of American Nalional Inslilules of Heallh slroke scale ( NIHSS) score. Methods MBP was measured in 328 old ACI palienls by ELISA. All old ACI palienls were classified inlo 5 groups based on ihe Trial of Org 10172 in Acule Slroke Trealmenl ( TOAST) criteria. And ihen ihe relationship belween MBP level and NIHSS score in differenl TOAST sublypes were analysed. Results The percentage of each ischemic stroke TOAST subtype was as follow; large - artery atherosclerosis 42. 99% , small - vessel occlusion 21. 95% , cardioembolism 15. 85% , stroke of undetermined etiology 15. 55% , stroke of other determined etiology 3. 66% . The serum level of MBP in cardioembolism, large - artery atherosclerosis and stroke of undetermined etiology subtypes increased after cerebral infarcl. The serum level of MBP of small - vessel occlusion subtype hasnl significantly changed in TOAST. Compared lo the SVO group, ihe serum level of MBP in LAA and CE have significant difference (P <0. 01). There was a positive correlation in LAA and SUE groups( r = 0. 68 , 0.51, P<0.05) and there was a negative correlation in CE and SAO groups. Apparently, olher factors, such as TC, TG, LDL - C, SBP, DBP, age and HDL - C, could also affect ihe level of MBP. Conclusion Different classifications have differenl serum level of MBP. There was a posilive correlationbelween MBP and NIHSS score in some subtypes. The serum level of MBP is relaled Lo ihe severity of ihe slale of cerebral infarclion Lo some degree.