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目的探讨急性脑梗死患者血清中胱抑素C(cystatin C,Cyst-C)的水平变化及其与急性脑梗死的TOAST病因分型的关系。方法选择2009年12月～2010年12月在皖南医学院弋矶山医院神经内科住院的急性脑梗死患者120例为病例组;选择年龄、性别、居住地与脑梗死组患者匹配的体检健康者60例作为对照组,均符合入组标准。并按照TOAST分型标准进行病因分型,用酶联免疫吸附法(ELISA)检测其血清Cyst-C浓度,分析TOAST各亚型与Cyst-C水平的关系。结果 (1)脑梗死组患者血清Cyst-C水平高于对照组(P<0.01);脑梗死TOAST各分型中SOE、SUE因例数少未作分析,其它各型中LAA、SAA、CE组血清Cyst-C水平高于对照组(P<0.01),其中以LAA组增高显著(P<0.01)。(2)经Logistic回归分析发现Cyst-C与大动脉粥样硬化型脑梗死的发生显著相关(OR值5.346 95%CI 2.225～12.846)。结论血清Cyst-c水平可能是急性脑梗死的一个独立危险因素,比传统危险因子更敏感地反映病情变化。Cyst-c水平随TOAST亚型的不同而变化,在LAA中浓度升高最显著,支持脑梗死不同亚型可能具有不同病因的论点。
Objective To investigate the serum levels of cystatin C (Cyst-C) in patients with acute cerebral infarction and its relationship with TOAST etiology in patients with acute cerebral infarction. Methods 120 cases of acute cerebral infarction hospitalized in Department of Neurology, Yijishan Hospital, Wannan Medical College from December 2009 to December 2010 were selected as the case group. The subjects whose age, sex, place of residence and cerebral infarction matched the healthy subjects 60 cases as a control group, are in line with the inclusion criteria. According to the TOAST classification criteria, the etiological types were determined. Serum Cyst-C concentration was detected by enzyme-linked immunosorbent assay (ELISA), and the relationship between TOAST subtypes and Cyst-C levels was analyzed. Results (1) Serum levels of Cyst-C in patients with cerebral infarction were significantly higher than those in controls (P <0.01). There was no significant difference in the number of SOE and SUE between TOAST and other types of cerebral infarction. LAA, SAA, CE Serum levels of Cyst-C were significantly higher in the LAA group than those in the control group (P <0.01). (2) Logistic regression analysis showed that Cyst-C was significantly associated with the incidence of atherosclerotic cerebral infarction (OR, 5.346 95% CI 2.225-12.846). Conclusion The serum level of Cyst-c may be an independent risk factor for acute cerebral infarction. It reflects the condition more sensitively than traditional risk factors. Cyst-c levels vary with the TOAST subtypes, with the most significant increase in LAA, supporting the argument that different subtypes of cerebral infarction may have different etiologies.