CAJ | 학술논문

目的：探讨缺血性脑卒中患者血清中视锥蛋白样蛋白1（VILIP-1）和N-甲基-D-门冬氨酸受体（ NMDA-R）裂解产物NR2多肽水平，并探讨其早期诊断的临床价值。方法采用病例对照研究，选取可疑短暂性脑缺血发作（ TIA，出现症状24 h内）或急性缺血性脑卒中（ IS，出现症状72 h内）患者340例、健康体检者102名、有血管危险因素的对照者98例和出血性脑卒中患者35例作为研究对象，利用ELISA检测血清中VILIP-1和NR2多肽的水平。各组间VILIP-1和NR2多肽水平采用非参数秩和检验进行差异分析，并对VILIP-1和NR2多肽水平进行组间的独立和联合诊断性能分析。结果 IS组血清中的VILIP-1和NR2多肽浓度分别为9.80（1.90～14.22）μg/L 和14.40（5.60～27.91）μg/L，显著高于健康对照组[ VILIP-1：0.02（0.01～0.09），NR2：0.33（0.02～1.15），χ2＝5.61、9.54，P＜0.001]、血管高危因素组[VILIP-1：0.03（0.02～0.16），NR2：0.27（0.01～1.54），χ2＝6.74、10.62，P＜0.001]和非脑卒中组[VILIP-1：0.04（0.03～0.19），NR2：0.53（0.45～1.21），χ2＝3.78、7.63，P＜0.001]。 VILIP-1和NR2多肽浓度在发病的最初3 h内显著升高。 NR2多肽浓度在IS组明显高于出血性脑卒中组[0.47（0.23～1.32）μg/L]，曲线下面积（AUC）为0.934，具有较强的诊断性能。 VILIP-1和NR2多肽联合检测区分IS与其他对照者时，AUC为0.974，显著高于单独检测VILIP-1（AUC＝0.849）和NR2（AUC＝0.862）的结果。结论 VILIP-1和NR2多肽是早期诊断IS比较敏感和特异的指标，二者联合应用可以提高IS患者早期的诊断率。（中华检验医学杂志，2014，37：469-472）
목적：탐토결혈성뇌졸중환자혈청중시추단백양단백1（VILIP-1）화N-갑기-D-문동안산수체（ NMDA-R）렬해산물NR2다태수평，병탐토기조기진단적림상개치。방법채용병례대조연구，선취가의단잠성뇌결혈발작（ TIA，출현증상24 h내）혹급성결혈성뇌졸중（ IS，출현증상72 h내）환자340례、건강체검자102명、유혈관위험인소적대조자98례화출혈성뇌졸중환자35례작위연구대상，이용ELISA검측혈청중VILIP-1화NR2다태적수평。각조간VILIP-1화NR2다태수평채용비삼수질화검험진행차이분석，병대VILIP-1화NR2다태수평진행조간적독립화연합진단성능분석。결과 IS조혈청중적VILIP-1화NR2다태농도분별위9.80（1.90～14.22）μg/L 화14.40（5.60～27.91）μg/L，현저고우건강대조조[ VILIP-1：0.02（0.01～0.09），NR2：0.33（0.02～1.15），χ2＝5.61、9.54，P＜0.001]、혈관고위인소조[VILIP-1：0.03（0.02～0.16），NR2：0.27（0.01～1.54），χ2＝6.74、10.62，P＜0.001]화비뇌졸중조[VILIP-1：0.04（0.03～0.19），NR2：0.53（0.45～1.21），χ2＝3.78、7.63，P＜0.001]。 VILIP-1화NR2다태농도재발병적최초3 h내현저승고。 NR2다태농도재IS조명현고우출혈성뇌졸중조[0.47（0.23～1.32）μg/L]，곡선하면적（AUC）위0.934，구유교강적진단성능。 VILIP-1화NR2다태연합검측구분IS여기타대조자시，AUC위0.974，현저고우단독검측VILIP-1（AUC＝0.849）화NR2（AUC＝0.862）적결과。결론 VILIP-1화NR2다태시조기진단IS비교민감화특이적지표，이자연합응용가이제고IS환자조기적진단솔。（중화검험의학잡지，2014，37：469-472）
Objective To Investigate the concentration of VILIP-1 and NR2 peptide in the serum of patients with ischemic stroke , and to explore their clinic value in early diagnostic of ischemic stroke patients.Methods The levels of VILIP-1 and NR2 peptide were examined by ELISA ( enzyme linked immunosorbent assay ,ELISA) with suspicious TIA ( defined as a neurological deficit that resolved within 24 hours) or acute ischemic stroke patients ( within 72 hours of onset of symptoms ) 340 cases,102 healthy controls,98 patients with vascular risk factors and 35 patients with hemorrhagic stroke.Among all the groups , VILIP-1 and NR2 peptide level were analyzed using the nonparametric Wilcoxon test.Diagnostic performance were analyzed among the groups with the two biomarkers independently and combinedly .Results Serum levels of VILIP-1 and NR2 peptide in patients with ischemic stroke (IS) were 9.80 (1.90-14.22) μg/L, 14.40 (5.60-27.91) μg/L respectively,which was higher than that of the healthy control group [VILIP-1:0.02 (0.01-0.09),NR2:0.33 (0.02-1.15),χ2 were 5.61 and 9.54,P<0.001],the group with vascular risk factors [VILIP-1:0.03 (0.02-0.16),NR2:0.27 (0.01-1.54),χ2 were 6.74 and 10.62,P<0.001], the group of patients non-stoke [VILIP-1:0.04 (0.03-0.19),NR2:0.53 (0.45-1.21),χ2 were 3.78 and 7.63, P <0.001 ].The levels of VILIP-1 and NR2 peptide was significantly increased in IS patients presenting within 3 h of symptom onset.When differentiating IS from patients with hemorrhagic stroke ,NR2 had a AUC of 0.934,showing a strong distinguishing effectiveness.Differentiating IS from healthy controls , patients with vascular risk factors and non-stroke patients,the AUC of combination of VILIP-1 and NR2 was 0.974,which was higher than the AUC of either VILIP-1(0.849) or NR2(0.862) alone(P <0.05). Conclusions VILIP-1 and NR2 peptide are very sensitive and specific biomarkers to the early diagnosis of IS.The combination of VILIP-1 and NR2 peptide has higher value of clinical applications than one of them independently.