标题：NSE、D-二聚体及HCY检测对急性脑梗死患者预后的评估价值

      作者：李晶，邵勇，任漪清    复旦大学附属华东医院神经内科，上海 200042

      卷次： 2021年32卷7期

      【摘要】 目的 检测急性脑梗死(ACI)患者中神经元特异性烯醇化酶(NSE)、D-二聚体及同型半胱氨酸(HCY)的表达水平，以探讨NSE、D-二聚体、HCY在ACI预后评估中的应用价值。方法 选择2018年1月至2019年4月期间在复旦大学附属华东医院神经内科就诊的150例ACI患者作为研究对象(ACI组)，选择同期健康体检者150例作为对照组。根据病灶体积大小，将ACI组患者分为小体积梗死组(病灶体积<4.0 cm3) 46例，中体积梗死组(4.1~10.0 cm3)62例和大体积梗死组(>10.0 cm3) 42例，根据患者发病后3个月的改良 Rankin量表(mRS)评分将AC组患者分为预后良好组(mRS≤2分) 102例和预后不良组(mRS>2分或死亡) 48例。比较上述不同组间受检者的NSE、D-二聚体和HCY水平，采用受试者工作特征(ROC)分析NSE、D-二聚体、HCY及三者联合检测对ACI患者预后判断的价值。结果 ACI组患者的NSE、D-二聚体、HCY水平分别为(18.72±4.65) ng/mL、(3.50±1.23) mg/L、(18.60±4.67) μmol/L，明显高于对照组的(9.87±3.27) ng/mL、(0.30±0.08) mg/L、(12.18±2.25) μmol/L，差异均有显著统计学意义(P<0.01)；小体积梗死组患者的NSE、D-二聚体、HCY水平分别为(15.91±3.01) ng/mL、(2.36±0.50) mg/L、(15.64±3.20) μmol/L，明显低于中体积梗死组的(19.16±4.53) ng/mL、(3.31±0.62) mg/L、(18.04±4.16) μmol/L，中体积梗死组患者的NSE、D-二聚体、HCY水平明显低于大体积梗死组的(21.16±4.80) ng/mL、(5.02±0.89) mg/L、(22.68±3.82) μmol/L，差异均有统计学意义(P<0.05)；预后不良组患者的NSE、D-二聚体、HCY水平分别为(20.10±4.78) ng/mL、(4.21±1.19) mg/L、(21.38±3.89) μmol/L，明显高于预后良好组的(18.08±4.47) ng/mL、(3.16±1.11) mg/L、(17.30±4.44) μmol/L，差异均有统计学意义(P<0.05)；NSE、D-二聚体、HCY对ACI患者预后不良诊断价值的ROC曲线下面积分别为 0.64、0.75、0.76，三者联合则为0.80。结论 ACI患者NSE、D-二聚体、HCY表达水平显著升高，梗死体积越大，NSE、D-二聚体、HCY水平越高，预后不良患者NSE、D-二聚体、HCY水平显著高于预后良好患者，三者联合检测对ACI患者预后判断具有重要价值。
      【关键词】 急性脑梗死；神经元特异性烯醇化酶；D-二聚体；同型半胱氨酸；预后
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2021）07—0851—04

Prognostic value of neuron-specific enolase, D-dimer, and HCY in patients with acute cerebral infarction.
LIJing, SHAO Yong, REN Yi-qing. Department of Neurology, Huadong Hospital, Fudan University, Shanghai 200042, CHINA
【Abstract】 Objective To detect the expression levels of neuron-specific enolase (NSE), D-dimer, and homo-cysteine (HCY) in patients with acute cerebral infarction (ACI) and to investigate the application value of NSE, D-dimerand HCY in prognostic assessment of ACI. Methods A total of 150 patients with ACI who visited the Department ofNeurology, Huadong Hospital, Fudan University from January 2018 to April 2019 were selected as study subjects. A to-tal of 150 healthy subjects were selected as the control group. According to the lesion volume, ACI patients were dividedinto 46 patients in the small-volume infarction group (lesion volume<4.0 cm3), 62 patients in the medium-volume infarc-tion group (4.1—10.0 cm3), and 42 patients in the large-volume infarction group (>10.0 cm3) . According to the modifiedRankin scale (mRS) score 3 months after onset, ACI patients were divided into 102 patients in the good prognosis group(mRS≤2 points) and 48 patients in the poor prognosis group (mRS>2 points or death). The levels of NSE, D-dimer, andHCY in different groups were compared, and the value of NSE, D-dimer, HCY and their combined detection on ACI pa-tients was analyzed by ROC. Results The levels of NSE, D-dimer, and HCY in the ACI group were (18.72±4.65) ng/mL,(3.50±1.23) mg/L, and (18.60±4.67) μmol/L, respectively, which were significantly higher than corresponding (9.87±3.27) ng/mL, (0.30±0.08) mg/L, (12.18±2.25) μmol/L in the control group, all with statistically significant differences(all P<0.01). The levels of NSE, D-dimer, and HCY in the small-volume infarction group were (15.91±3.01) ng/mL,(2.36±0.50) mg/L, and (15.64±3.20) μmol/L, respectively, which were significantly lower than corresponding (19.16±4.53) ng/mL, (3.31±0.62) mg/L, (18.04±4.16) μmol/L in the medium-volume infarction group (all P<0.05). The levels ofNSE, D-dimer, and HCY in the medium-volume infarction group were significantly lower than corresponding (21.16 ±4.80) ng/mL, (5.02±0.89) mg/L, and (22.68±3.82) mol/L in the large-volume infarction group, with statistically signifi-cant differences (P<0.05). The NSE, D-dimer, and HCY levels of ACI patients in the group with poor prognosis were