血清半胱氨酸蛋白酶抑制剂C在急性脑卒中并发血管性认知障碍中的诊断价值(1)
【摘要】目的探讨血清半胱氨酸蛋白酶抑制剂C(CysC)在急性脑卒中并发血管性认知障碍(VCI)中的诊断价值。
方法收集2013年4月至2014年8月住院治疗的急性脑卒中患者100例，根据是否合并有VCI分为VCI组58例，非VCI组42例。另外选择同期常规体检的45例健康人员作为对照组。比较各组血清CysC浓度的差异，并分析其与VCI患者的简易精神状态评价(MMSE)的相关性。
结果非VCI组与对照组血清CysC浓度差异无统计学意义(P>0.05)，VCI组血清CysC浓度明显高于非VCI组和对照组(P<0.001)。中度VCI患者血清CysC浓度明显高于轻度VCI患者，重度VCI患者血清CysC浓度明显高于中度和轻度VCI患者(P<0.05或0.01)。Spearman相关性分析显示，VCI患者MMSE评分与血清CysC浓度呈负相关(P<0.05)。
结论 CysC可明显抑制组织蛋白酶，在急性脑卒中合并认知功能障碍的发生进展中具有一定作用。其有可能作为急性脑卒中患者并发认知功能障碍诊断、监测及预后评估的指标。
【关键词】血清半胱氨酸蛋白酶抑制剂C；急性脑卒中；血管性认知障碍
中图分类号：R743.31文献标识码：ADOI：10.3969/j.issn.10031383.2016.01.017
【Abstract】ObjectiveTo investigate the diagnostic value of serum cysteine protease inhibitor C(CysC) in the diagnosis of acute cerebral apoplexy complicated by vascular cognitive impairment(VCI).
MethodsFrom April， 2013 to August， 2014， 100 cases of acute cerebral apoplexy were selected. All cases were divided into VCI group (58 cases) and non VCI group (42 cases ) according to whether the patients had VCI or not. Meanwhile， another 45 healthy persons who received routine physical examination during the same period were selected as control group. Then， serum CysC concentrations were compared among the groups， and the correlation between CysC concentrations and MiniMental State Examination (MMSE) of VCI patients was analyzed.
Results There was no significant difference between CysC concentrations in non VCI group and the control group(P>0.05)， the serum CysC concentration in the VCI group was significantly higher than those in the non VCI group and the control group(P<0.001). The concentrations of serum CysC in patients with moderate VCI were significantly higher than those in patients with mild VCI， and concentration of serum CysC in patients with severe VCI was higher than those in patients with moderate and mild VCI(P<0.05 or 0.01). Spearman correlation analysis showed that the MMSE score of VCI patients was negatively correlated with concentrations of serum CysC(P<0.05).
ConclusionCysC can obviously inhibit cathepsin， which plays a part in occurrence development of acute cerebral apoplexy complicated by VCI. As a result， it may serve as an indicator for the diagnosis， monitoring and prognosis of acute stroke patients with VCI.
【Key words】CysC； acute cerebral apoplexy； VCI
血管性认知障碍(vascular cognitive impairment，VCI)是近年来提出的一个新概念，指由脑血管疾病危险因素(高血压、糖尿病、高血脂等)、明显(脑梗死等)或不明显(白质疏松等)脑血管疾病所致的包括轻度认知障碍到痴呆的一大类综合征[1]。该病涉及血管源性认知损害由轻至重的发病过程，其概念提出的目的是让人们重视其早期诊治，使病情未进展至痴呆时即得到有效的治疗。VCI的早期诊治，即在患者伴有血管性认知功能障碍的早期阶段，尚未影响其日常生活能力时进行干预，可预防进展为不可逆的血管性痴呆晚期阶段。如何对VCI进行早期诊断及治疗，目前尚无统一结论。通过检测与认知功能损害相关的血清学指标可能对VCI的早期诊断及治疗有帮助。有研究发现，血半胱氨酸蛋白酶抑制剂C(CysC与人的认知功能损害相关[2]。本研究检测100例急性脑卒中患者血清CysC水平，分析其与患者并发VCI的相关性，旨在获得一种能有效反映VCI发生的指标，以利于指导该病的早期诊断和治疗，现报道如下。, http://www.100md.com(王玮 纪元)
方法收集2013年4月至2014年8月住院治疗的急性脑卒中患者100例，根据是否合并有VCI分为VCI组58例，非VCI组42例。另外选择同期常规体检的45例健康人员作为对照组。比较各组血清CysC浓度的差异，并分析其与VCI患者的简易精神状态评价(MMSE)的相关性。
结果非VCI组与对照组血清CysC浓度差异无统计学意义(P>0.05)，VCI组血清CysC浓度明显高于非VCI组和对照组(P<0.001)。中度VCI患者血清CysC浓度明显高于轻度VCI患者，重度VCI患者血清CysC浓度明显高于中度和轻度VCI患者(P<0.05或0.01)。Spearman相关性分析显示，VCI患者MMSE评分与血清CysC浓度呈负相关(P<0.05)。
结论 CysC可明显抑制组织蛋白酶，在急性脑卒中合并认知功能障碍的发生进展中具有一定作用。其有可能作为急性脑卒中患者并发认知功能障碍诊断、监测及预后评估的指标。
【关键词】血清半胱氨酸蛋白酶抑制剂C；急性脑卒中；血管性认知障碍
中图分类号：R743.31文献标识码：ADOI：10.3969/j.issn.10031383.2016.01.017
【Abstract】ObjectiveTo investigate the diagnostic value of serum cysteine protease inhibitor C(CysC) in the diagnosis of acute cerebral apoplexy complicated by vascular cognitive impairment(VCI).
MethodsFrom April， 2013 to August， 2014， 100 cases of acute cerebral apoplexy were selected. All cases were divided into VCI group (58 cases) and non VCI group (42 cases ) according to whether the patients had VCI or not. Meanwhile， another 45 healthy persons who received routine physical examination during the same period were selected as control group. Then， serum CysC concentrations were compared among the groups， and the correlation between CysC concentrations and MiniMental State Examination (MMSE) of VCI patients was analyzed.
Results There was no significant difference between CysC concentrations in non VCI group and the control group(P>0.05)， the serum CysC concentration in the VCI group was significantly higher than those in the non VCI group and the control group(P<0.001). The concentrations of serum CysC in patients with moderate VCI were significantly higher than those in patients with mild VCI， and concentration of serum CysC in patients with severe VCI was higher than those in patients with moderate and mild VCI(P<0.05 or 0.01). Spearman correlation analysis showed that the MMSE score of VCI patients was negatively correlated with concentrations of serum CysC(P<0.05).
ConclusionCysC can obviously inhibit cathepsin， which plays a part in occurrence development of acute cerebral apoplexy complicated by VCI. As a result， it may serve as an indicator for the diagnosis， monitoring and prognosis of acute stroke patients with VCI.
【Key words】CysC； acute cerebral apoplexy； VCI
血管性认知障碍(vascular cognitive impairment，VCI)是近年来提出的一个新概念，指由脑血管疾病危险因素(高血压、糖尿病、高血脂等)、明显(脑梗死等)或不明显(白质疏松等)脑血管疾病所致的包括轻度认知障碍到痴呆的一大类综合征[1]。该病涉及血管源性认知损害由轻至重的发病过程，其概念提出的目的是让人们重视其早期诊治，使病情未进展至痴呆时即得到有效的治疗。VCI的早期诊治，即在患者伴有血管性认知功能障碍的早期阶段，尚未影响其日常生活能力时进行干预，可预防进展为不可逆的血管性痴呆晚期阶段。如何对VCI进行早期诊断及治疗，目前尚无统一结论。通过检测与认知功能损害相关的血清学指标可能对VCI的早期诊断及治疗有帮助。有研究发现，血半胱氨酸蛋白酶抑制剂C(CysC与人的认知功能损害相关[2]。本研究检测100例急性脑卒中患者血清CysC水平，分析其与患者并发VCI的相关性，旨在获得一种能有效反映VCI发生的指标，以利于指导该病的早期诊断和治疗，现报道如下。, http://www.100md.com(王玮 纪元)