标题：急性缺血性脑卒中合并脑微出血患者血清Hcy、UA、炎症指标和认知功能的变化及临床意义

      作者：徐杰，谢雪梅    安康市中心医院神经内科，陕西 安康 725000

      卷次： 2020年31卷20期

      【摘要】 目的 观察急性缺血性脑卒中合并脑微出血患者血清同型半胱氨酸(Hcy)、尿酸(UA)、炎症指标和认知功能的变化，并探讨其临床意义。方法 回顾性分析2017年5月至2019年5月期间在安康市中心医院确诊的110例急性缺血性脑卒中患者的诊疗情况。根据患者是否合并脑微出血分组，其中55例急性缺血性脑卒中患者作为对照组，55例急性缺血性脑卒中合并脑微出血患者作为研究组。比较两组患者入院后的血清Hcy、UA及超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α (TNF-α)、白介素-6 (IL-6)、白介素-1β (IL-1β)水平，并通过MoCA量表测定两组患者入院时的认知功能。结果 研究组和对照组患者入院后的血清Hcy [(14.3±3.2) μmol/L vs (10.58±2.78) μmol/L]、UA[(420.41±64.98) μmol/L vs (353.88±67.8) μmol/L]、hs-CRP [(6.3±1.72) μmol/L vs (1.58±0.18) μmol/L]、TNF-α [(35.41±6.98) pg/mL vs (20.88±4.8) pg/mL]、IL-6 [(14.3±1.2) pg/mL vs (6.58±1.3) pg/mL]、IL-1β [(70.1±10.9) pg/mL vs (8.4±1.6) pg/mL]水平比较，研究组明显高于对照组，差异均有统计学意义(P<0.05)；研究组和对照组患者入院时的语言能力[(3.18±0.83)分 vs (4.53±0.60)分]、抽象思维[(0.6±0.13)分 vs (1.3±0.11)分]、定向力[(5.6±0.78)分 vs (6.3±0.82)分]、注意力与计算力[(4.4±0.67)分 vs (5.1±0.83)分]、视空间及执行能力[(3.67±0.69)分 vs (4.90±0.58)分]、延迟回忆[(2.45±0.78)分vs (3.33±0.63)分]等认知功能评分比较，研究组明显低于对照组，差异均有统计学意义(P<0.05)。结论 检测急性缺血性脑卒中患者的血清Hcy、UA、炎症指标以及测定患者的认知功能，能帮助临床医生及时有效的掌握患者病情发展情况，指导临床医生开展有效治疗，对临床诊治具有实用价值。
      【关键词】 急性；缺血性脑卒中；脑微出血；同型半胱氨酸；尿酸；炎症指标；临床意义
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2020）20—2602—03

Changes and clinical significance of serum Hcy, UA, inflammatory indexes and cognitive function in patients withacute ischemic stroke complicated with cerebral microbleeds.
XU Jie, XIE Xue-mei. Department of Neurology, AnkangCentral Hospital, Ankang 725000, Shaanxi, CHINA
【Abstract】 Objective To observe the changes of serum homocysteine (Hcy), uric acid (UA), inflammatory in-dexes and cognitive function in patients with acute ischemic stroke complicated with cerebral microbleeds, and to ex-plore their clinical significance. Methods The diagnosis and treatment of 110 patients with acute ischemic stroke diag-nosed in Ankang Central Hospital from May 2017 to May 2019 were retrospectively analyzed. According to whether thepatients were combined with cerebral microbleeds, 55 cases of acute ischemic stroke patients were selected as the con-trol group, 55 cases of acute ischemic stroke patients with cerebral microbleeds were enrolled into the study group. Thelevels of serum Hcy, UA, hs-CRP, TNF-α, IL-6, and IL-1β after admission were compared between the two groups. Thecognitive function of the two groups was measured by MOCA scale. Results After admission, serum Hcy, UA, hs-CRP,TNF-α, IL-6 and IL-1β of the study group were (14.3±3.2) μmol/L, (420.41±64.98) μmol/L, (6.3±1.72) μmol/L, (35.41±6.98) pg/mL, (14.3 ± 1.2) pg/mL, (70.1 ± 40.9) pg/mL, respectively, which were significantly higher than corresponding(10.58±2.78) μmol/L, (353.88±67.8) μmol/L, (1.58±0.18) μmol/L, (20.88±4.8) pg/mL, (6.58±1.3) pg/mL, (8.4±3.6) pg/mLin the control group (all P<0.05). On admission, the the cognitive function scores including linguistic competence, abstractthinking, directional force, attention and calculation force, visual space and executive ability, delayed recall in the study groupwere (3.18±0.83) points, (0.6±0.13) points, (5.6±0.78) points, (4.4±0.67) points, (3.67±0.69) points, (2.45±0.78) points, re-spectively, which were significantly lower than corresponding (4.53±0.60) points, (1.3±0.11) points, (6.3±0.82) points,(5.1±0.83) points, (4.90±0.58) points, (3.33±0.63) points of the control group (all P<0.05). Conclusion Detection of se-rum Hcy, UA, inflammatory indexes and cognitive function of patients with acute ischemic stroke can help clinicians tograsp the development of patients' condition in time and effectively, and guide clinicians to carry out effective treatment,which has practical value for clinical diagnosis and treatment.
      【Key words】 Acute; Ischemic stroke; Cerebral microbleeds; Homocysteine; Uric acid; Inflammatory biomarkers;Clinical significance