2020 年第 4 期 第 15 卷

检测血清同型半胱氨酸和C反应蛋白对急性脑梗死患者的临床诊断价值

Diagnostic values of serum homocysteine and C-reactive protein in patients with acute cerebral infarction

作者：王大平李琳尹纪来

英文作者：Wang Daping Li Lin Yin Jilai

单位：海南医学院第一附属医院检验科，海口570102

英文单位：Department of Laboratory the First Affiliated Hospital of Hainan Medical College Haikou 570102 China

关键词：急性脑梗死；同型半胱氨酸；C反应蛋白；诊断

英文关键词：Acutecerebralinfarction；Homocysteine；C-reactiveprotein；Diagnosis

• 摘要：

• 【摘要】目的    探讨检测血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)对急性脑梗死患者的临床诊断价值。方法    选取2018年1月至2019年4月海南医学院第一附属医院收治的70例急性脑梗死患者（观察组），均经影像学检查确诊为急性脑梗死，其中大面积梗死(直径＞3.0 cm)25例、中面积梗死(直径1.5～3.0 cm)30例、小面积梗死(直径＜1.5 cm)15例；同时选取70名于医院健康体检的健康正常人群作为对照组。比较2组受试者血清Hcy、CRP水平。以影像学检查作为金标准，以50例观察组和20名对照组为研究对象，分析单独或联合检测血清Hcy、CRP对急性脑梗死的诊断价值。结果    观察组血清Hcy、CRP水平均明显高于对照组［(19.62±2.41)μmol/L比(4.47±0.22)μmol/L、(15.7±1.6)mg/L比(2.9±1.5)mg/L］，差异均有统计学意义（均P＜0.001）。大面积梗死患者血清Hcy、CRP水平明显高于中、小面积梗死患者，中面积梗死患者血清Hcy、CRP水平明显高于小面积梗死患者，差异均有统计学意义（均P＜0.05）。联合检测血清Hcy、CRP诊断急性脑梗死的准确率、特异度、敏感度、阳性预测值及阴性预测值明显高于单独检测血清Hcy、CRP［91.4%(64/70)比61.4%(43/70)、67.1%(47/70)，85.0%(17/20)比60.0%(12/20)、70.0%(14/20)，94.0%(47/50)比62.0%(31/50)、66.0%(33/50)，94.0%(47/50)比79.5%(31/39)、84.6%(33/39)，85.0%(17/20)比38.7%(12/31)、45.2%(14/31)］，且漏诊率、误诊率明显低于单独检测血清Hcy、CRP［6.0%(3/50)比38.0%(19/50)、34.0%(17/50)，15.0%(3/20)比40.0%(8/20)、30.0%(6/20)］，差异均有统计学意义（均P＜0.05）。结论    检测血清Hcy、CRP水平有助于临床医师诊断和评估急性脑梗死患者病情，且联合检测两项指标的诊断价值更高。

• 【Abstract】Objective    To explore the values of serum homocysteine(Hcy) and C-reactive protein(CRP) in clinical diagnosis of acute cerebral infarction. Methods    From January 2018 to April 2019, 70 patients diagnosed as acute cerebral infarction in the First Affiliated Hospital of Hainan Medical College were enrolled as observation group, including 25 cases of large infarction（＞3.0 cm）, 30 cases of medium infarction(1.5-3.0 cm) and 15 cases of small infarction(＜1.5 cm); 70 healthy people were enrolled as control group. Serum levels of Hcy and CRP were detected. Diagnostic values of Hcy and CRP for acute cerebral infarction were analyzed using imaging examination as standard criteria. Results    Serum levels of Hcy and CRP in observation group were significantly higher than those in control group［(19.62±2.41)μmol/L vs (4.47±0.22)μmol/L, (15.7±1.6)mg/L vs (2.9±1.5)mg/L］（both P＜0.001）. Higher levels of Hcy and CRP were observed with greater infarction area(all P＜0.05). Combined Hcy and CRP in diagnosis of acute cerebral infarction showed higher accuracy, specificity, sensitivity, positive predictive value, negative predictive value［91.4%(64/70) vs 61.4%(43/70), 67.1%(47/70); 85.0%(17/20) vs 60.0%(12/20), 70.0%(14/20); 94.0%(47/50) vs 62.0%(31/50), 66.0%(33/50); 94.0%(47/50) vs 79.5%(31/39), 84.6%(33/39); 85.0%(17/20) vs 38.7%(12/31), 45.2%(14/31)］ and lower rates of missed diagnosis and misdiagnosis［6.0%(3/50) vs 38.0%(19/50), 34.0%(17/50); 15.0%(3/20) vs 40.0%(8/20), 30.0%(6/20)］ than separate detection（all P＜0.05）. Conclusion    Detection of serum Hcy and CRP is valuable in clinical diagnosis of acute cerebral infarction and evaluating the severity of disease; combined detection of the two indicators shows better efficiency.