急性脑梗死患者 LDL-C、Hcy、Npt、CRP 水平的改变及其与颈动脉粥样硬化的关系

摘要

目的：探讨急性脑梗死（ ACI）患者低密度脂蛋白胆固醇（ LDL-C）、同型半胱氨酸（ Hcy）、新蝶呤（ Npt）、C反应蛋白（ CRP）水平的改变及其与颈动脉粥样硬化的关系。方法2014年6月—2015年6月诊治ACI死患者68例为ACI组，选取同期行健康检查的体检者60例为健康对照组，应用多普勒超声仪测定2组颈动脉内膜中层厚度（ IMT），ELISA法测定2组血浆Hcy、Npt，酶直接法测定血浆LDL-C，乳胶免疫比浊法测定CRP。结果 ACI组患者颈动脉斑块发生率为91潩．17％，显著高于健康对照组10．00％（ P ＜0．05）；ACI组血浆LDL-C（4．98±0．89）mmol／L、Hcy（38．96±4．89）μmol／L、Npt（2．45±0．48） ng／ml、CRP（6．89±0．48） mg／L水平高于健康对照组（2．86±0．93） mmol／L、（18．02±3．88）μmol／L、（1．38±0．59）ng／ml、（1．58±0．56）mg／L（ P ＜0．05），而颈动脉IMT（1．85±0．32） mm大于健康对照组（0．42±0．16），差异均有统计学意义（ P ＜0．05）。 ACI患者中软斑亚组、混合斑亚组血浆LDL-C、Hcy、Npt、CRP水平显著高于硬斑亚组（ P ＜0．05）。经Pearson单因素分析，血浆LDL-C、Hcy、Npt、CRP水平与IMT呈正相关（ r ＝0．412、0．326、0．345、0．369， P ＜0．05）。结论 ACI合并颈动脉不稳定斑块患者血浆LDL-C、Hcy、Npt、CRP水平显著高于斑块不稳定患者，提示血浆LDL-C、Hcy、Npt、CRP水平可反映ACI患者颈动脉粥样硬化稳定性。%Objective To investigate acute cerebral infarction ( ACI) patients of low density lipoprotein cholesterol (LDL-C), homocysteine (Hcy) and neopterin (Npt), C-reactive protein (CRP) levels and their relationships with carotid atherosclerosis.Methods From June 2014 to June 2015, 68 cases of ACI dead patients as ACI group, selected the same pe-riod in the hospital for health examination's 60 cases of healthy control as control group, two groups of carotid artery intima-media thickness ( IMT) by Doppler ultrasound were measured, ELISA method were used for the determination of 2 groups'plasma Hcy and Npt, direct enzymatic were used to measure plasma LDL-C, immuno latex turbidimetric method were used to measure CRP.Results ACI patients'carotid artery plaque incidence rate was 91.17%, significantly higher than that in the healthy control group (10.00%, P <0.05), ACI group's the plasma level of LDL-C was (4.98 ±0.89) mmol/L, Hcy was (38.96 ±4.89) mol/L Npt was (2.45 ±0.48) ng/ml, CRP was (6.89 ±0.48) mg/L, which were higher than that in the healthy control group (2.86 ±0.93) mmol/L, (18.02 ±3.88) μmol/L, (1.38 ±0.59) ng/ml, (1.58 ±0.56) mg/L, and carotid artery IMT (1.85 ±0.32) mm was greater than that in the healthy control group (0.42 ±0.16) mm, the differences were statistically significant ( P <0.05).ACI patients'soft spot subgroups, mixed plaque subgroups'plasma LDL-C, Hcy, Npt and CRP levels were significantly higher than those of the hard plaque subgroups ( P <0.05).By Pearson univariate analysis, plasma LDL-C, Hcy, Npt, CRP and IMT was positively correlated ( r =0.412, r =0.326, r =0.345, r =0.369, P <0.05).Conclusion ACI with Carotid plaque instability of plasma LDL-C, Hcy, Npt, CRP levels were significantly higher than the unstable plaque group, suggesting that plasma LDL-C, Hcy, Npt, CRP levels may reflect the level of the ca-rotid artery in patients with ACI atherosclerosis stability.