CAJ | 학술논문

目的探讨血浆α2巨球蛋白(α2-MG)水平与小动脉闭塞型(SAO)脑梗死发病及认知功能的关系.方法在青岛大学附属医院神经内科自2012年12月至2013年9月收治的患者中选取符合TOAST分型中SAO型脑梗死患者58例(SAO组)、大动脉粥样硬化型(LAA)脑梗死患者56例(LAA组)以及同期体检健康的正常者53例(健康对照组),应用酶联免疫吸附测定法(ELISA)检测血浆α2-MG水平并比较组间差异,绘制受试者工作特征曲线(ROC)判断血浆α2-MG水平对SAO型脑梗死的诊断价值.同时对SAO组进行简易精神状态量表(MMSE)测评,并对其颅脑MRI进行Fazekas评分评判脑白质损害(WMLs)程度,比较不同WMLs程度患者血浆α2-MG水平差异,分析血浆α2-MG水平与MMSE量表评分及Fazekas评分的相关性.结果与LAA组[(5.04±1.93) μg/mL]、健康对照组[(4.86±1.68) μg/mL]相比,SAO组血浆α2-MG水平[(6.70±3.17)μg/mL]明显增高,差异均有统计学意义(P＜0.05);二元Logistic回归分析显示血浆α2-MG水平是SAO型脑梗死的独立危险因素(OR=1.409,P=0.001;OR=1.443,P=0.004).ROC曲线显示4.23μg/mL α2-MG水平为诊断SAO型脑梗死的最佳临界值,灵敏度可达86.2％.不同WMLs程度的SAO型脑梗死患者间血浆α2-MG水平差异有统计学意义(F=26.509,P=0.000),且血浆α2-MG水平与Fazekas评分呈正相关(r=0.733,P=0.000),与MMSE量表评分呈负相关(r=-0.679,P=0.000).结论 α2-MG可作为诊断SAO型脑梗死的血浆标志物,是其独立危险因素,且其水平与认知功能障碍程度及WMLs程度密切相关.
목적 탐토혈장α2거구단백(α2-MG)수평여소동맥폐새형(SAO)뇌경사발병급인지공능적관계.방법 재청도대학부속의원신경내과자2012년12월지2013년9월수치적환자중선취부합TOAST분형중SAO형뇌경사환자58례(SAO조)、대동맥죽양경화형(LAA)뇌경사환자56례(LAA조)이급동기체검건강적정상자53례(건강대조조),응용매련면역흡부측정법(ELISA)검측혈장α2-MG수평병비교조간차이,회제수시자공작특정곡선(ROC)판단혈장α2-MG수평대SAO형뇌경사적진단개치.동시대SAO조진행간역정신상태량표(MMSE)측평,병대기로뇌MRI진행Fazekas평분평판뇌백질손해(WMLs)정도,비교불동WMLs정도환자혈장α2-MG수평차이,분석혈장α2-MG수평여MMSE량표평분급Fazekas평분적상관성.결과 여LAA조[(5.04±1.93) μg/mL]、건강대조조[(4.86±1.68) μg/mL]상비,SAO조혈장α2-MG수평[(6.70±3.17)μg/mL]명현증고,차이균유통계학의의(P＜0.05);이원Logistic회귀분석현시혈장α2-MG수평시SAO형뇌경사적독립위험인소(OR=1.409,P=0.001;OR=1.443,P=0.004).ROC곡선현시4.23μg/mL α2-MG수평위진단SAO형뇌경사적최가림계치,령민도가체86.2％.불동WMLs정도적SAO형뇌경사환자간혈장α2-MG수평차이유통계학의의(F=26.509,P=0.000),차혈장α2-MG수평여Fazekas평분정정상관(r=0.733,P=0.000),여MMSE량표평분정부상관(r=-0.679,P=0.000).결론 α2-MG가작위진단SAO형뇌경사적혈장표지물,시기독립위험인소,차기수평여인지공능장애정도급WMLs정도밀절상관.
Objective To investigate the relationships of plasma alpha2-macroglobulin (α2-MG) level with occurrence of small-artery occlusion (SAO) and cognitive function in SAO patients.Methods Subjects were collected in our hospital from December 2012 to September 2013;58 patients with SAO stroke,56 with large artery atherosclerosis (LAA) classified by Trial of Org 10172 in Acute Stroke Treatment (TOAST),as well as 58 healthy controls,were enrolled.The serum α2-MG levels were measured by enzyme-linked immunosorbent assay (ELISA) and compared among the three groups.The receiver operating characteristic (ROC) curve was drawn to evaluate the value of α2-MG as a biomarker for SAO.White matter lesions (WMLs) were assessed by MRI using Fazekas classification,and mini-mental state examination (MMSE) was used to evaluate the cognitive function.The correlations of plasma α2-MG level with both Fazekas scores and MMSE scores were analyzed.Results The serum α2-MG levels in SAO patients ([6.70±3.17] μg/mL) were significantly higher than those in LAA patients ([5.04±1.93] μg/mL) and controls ([4.86±1.68] μg/mL) (P＜0.05).Binary Logistic regression analysis showed that the plasma α2-MG level was an independent risk factor for occurrence of SAO (OR=1.409,P=0.001;OR=1.443,P=0.004).The ROC curves obtained that α2-MG=4.23 μg/mL was the cutoff values for SAO,enjoying sensitivity up to 86.2％.SAO patients with different severities of WMLs had significantly different serum α2-MG levels (F=26.509,P=0.000);the serum α2-MG levels were positively correlated with Fazekas scores (r=0.733,P=0.000) and negatively correlated with MMSE scores (r=-0.679,P=0.000).Conclusions Serum α2-MG level is an independent risk factor for SAO and might be a biomarker for SAO.Furthermore,serum α2-MG level,being associated with high-grade WMLs,might contribute to evaluating the cognitive impairment in SAO patients.