维生素D与微栓子信号及动脉粥样硬化性脑梗死患者预后的相关性

发布时间：2018-07-17 19:42

【摘要】：目的:本文旨在探讨血清维生素D浓度与微栓子信号检测的相关性,并进一步探讨前者与大动脉粥样硬化型脑梗死患者预后的关系。方法:纳入103例颈内动脉(internal carotid artery ICA)或大脑中动脉(middle cerebral artery MCA)供血区的动脉粥样硬化性脑梗死(1arge artery atheroscleros LAA)急性期的患者(LAA组),58例同期健康体检人群为对照组。应用ELISA法检测所有受试者维生素D(Vitamin D)浓度,两组之间进行维生素D浓度比较并采用二元Logistic相关回归分析LAA脑卒中患者的危险因素;将LAA组患者根据微栓子(microembolic signals MES)检测结果,分为微栓子阳性组MES(+)(29例)与微栓子阴性组MES(-)(74例),分析维生素D浓度与微栓子结果的相关性,并应用受试者工作特征(ROC)曲线评估维生素D浓度区分微栓子阳性的价值;对LAA组患者随访3个月,结合改良Ranking量表(m RS)评分,分为预后良好组(m RS评分3分)及预后不良组(m RS评分≥3分),比较两组维生素D浓度,并ROC曲线评估维生素D浓度对LAA型脑卒中患者预后的预测价值。结果:脑梗死患者血清维生素D水平(19.47±16.78)ng/ml明显低于对照组(38.00±25.02)ng/ml,差异有统计学意义(P0.01),二元Logistic回归分析维生素D(OR=0.960,95%CI:0.940-0.980)是大动脉粥样硬化性脑卒中的独立保护因素。MES阳性患者的血清维生素D水平(10.90±6.50)ng/m L低于MES阴性组(22.83±18.34)ng/m L,差异有统计学意义(P0.01)。预后不良组维生素D浓度显著低于预后良好组(12.37±8.22VS27.00±20.04)差异有统计学意义(P0.01)。应用维生素D浓度水平区分大动脉粥样硬化患者中微栓子阳性与微栓子阴性,ROC曲线下面积0.757,MES阳性与MES阴性最佳临界值为13.99ng/m L,灵敏度及特异度分别为73.0%,72.4%。同时应用维生素D评估LAA型脑梗死患者预后,其ROC曲线面积为0.797,最佳诊断临界值17.97ng/m L(灵敏度64.0%,特异度88.7%)。结论:LAA型患者较健康对照组人群血清维生素D浓度降低。MES(+)组较MES(-)组维生素D浓度显著降低。维生素D浓度在LAA型脑卒中预后不良组中较预后良好组显著降低。维生素D可以作为提示LAA型脑卒中微栓子存在及预测预后不良的血浆指标。
[Abstract]:Objective: to investigate the relationship between serum vitamin D concentration and microemboli signal detection, and the relationship between the former and the prognosis of patients with atherosclerotic cerebral infarction. Methods: a total of 58 healthy controls were enrolled in the acute stage of acute cerebral infarction (LAA group) in patients with acute cerebral infarction (LAA group) in the (internal carotid artery of internal carotid artery (ICA) or (middle cerebral artery MCA of middle cerebral artery (MCA). The concentration of vitamin D in all subjects was detected by Elisa, and the risk factors of stroke patients in LAA patients were analyzed by binary Logistic correlation regression analysis, and the results of microemboli (microembolic signals mes were used to detect the risk factors of stroke patients in LAA group. There were 29 cases of mes () (in positive microemboli group and 74 cases of mes (-) in microembolus negative group. The correlation between vitamin D concentration and the results of microemboli was analyzed, and the value of vitamin D concentration in differentiating microemboli positive was evaluated by the operating characteristic curve of subjects (ROC). The patients in LAA group were followed up for 3 months. The patients were divided into good prognosis group (Mrs score 3 points) and poor prognosis group (Mrs score 鈮，

本文编号：2130732