缺血性脑卒中患者血清超敏C反应蛋白、糖化血红蛋白水平及其与神经功能缺损的关系

目的:探讨缺血性脑卒中患者血清超敏C反应蛋白(hs-CRP)、糖化血红蛋白(HbA1c)水平及其与神经功能缺损的关系。方法:选择2016年10月~2017年9月我院接诊的123例缺血性脑卒中患者作为观察组及同期于我院进行体检的健康人群123例作为对照组,检测和比较两组血清hs-CRP、HbA1c水平的差异,并分析缺血性脑卒中患者血清hs-CRP、HbA1c水平与其美国国立卫生研究院卒中量表(NIHSS)评分的关系。结果:观察组患者血清hs-CRP、Hb A1c水平显著高于对照组[(6.23±1.97)mg/L、(7.96±0.65)%vs.(2.54±0.85)mg/L、(5.21±0.30)%],NIHSS评分明显高于对照组[(4.08±3.12)分vs. 8.62±3.25)分],差异具有统计学意义(P0.05);缺血性脑卒中患者血清hs-CRP、Hb A1c水平与NIHSS评分呈显著正相关(r=-0.465,-0.564,P0.05)。结论:缺血性脑卒中患者血清hs-CRP和HbA1c水平均明显上调,二者可以在一定程度上反映缺血性脑卒中患者神经功能缺损的严重程度。     

缺血性脑卒中患者血清C-反应蛋白和内皮素-1水平变化及临床意义

目的:探讨缺血性脑卒中患者不同病变时期血清C-反应蛋白(CRP)和内皮素-1(ET-1)水平变化与缺血性脑卒中关系.方法:临床确诊缺血性脑卒中患者68例,分别检测不同病变时期(入院时、入院第7天和出院前)的血清CRP和ET-1的含量,并记录病例的神经功能缺损评分.选择30例除外心脑血管疾病的体检者作为对照组.结果:①血清CRP含量在入院时、入院第7天和出院前分别为6.83±1.51 mg/L、4.89±1.33 mg/L、4.12±1.24 mg/L.较对照组(2.82±0.66 mg/L)均有显著升高(p＜0.05);血清ET-1含量在入院时、入院第7天和出院前分别为133.69±38.93 ng/L、125.234±32.45 ng/L、108.32±31.51 ng/L,较对照组(45.67±10.02mg/L)均有显著升高(p＜0.01).②随着病程的发展,CRP含量逐渐下降,与病程呈负相关,与神经功能缺损评分呈正相关;ET-1含量也逐渐下降,但仍维持在较高水平,与病程进展和神经功能缺损程度无明显的相关性.结论:缺血性脑卒中患者血清CRP和ET-1水平存在着动态变化.随着病情恢复,CRP含量明显下降,但ET-1含量仍维持在较高水平.     

蒺藜总皂苷对缺血性脑卒中患者血清C反应蛋白及血液流变学的影响

目的:观察蒺藜总皂苷(GSTT)对缺血性脑卒中患者血清C-反应蛋白(CRP)及血液流变学的影响.方法:本研究采用前瞻性开放性病例对照研究,将103例急性缺血性脑卒中患者随机分为治疗组和对照组:对照组(50例)采用常规治疗;治疗组(53例)在常规治疗的基础上加GSTT(30mg/次,一日三次)口服,于治疗前以及治疗28 d后检测患者CRP及血液流变学指标.结果:两组患者治疗后CRP均低于治疗前,差异有显著性(P＜0.01);GSTT可显著降低全血黏度、血浆黏度、纤维蛋白原水平,与治疗前比,差异有显著性(P＜0.05).结论:急性缺血性脑卒中患者血清CRP增高,血液流变学指标异常,GSTT可降低其CRP,改善血液流变学指标.     

新生儿血培养病原菌分布及与超敏C-反应蛋白的关系

目的分析新生儿血培养阳性标本中各病原菌分布情况及与hs-CRP的相关性。方法统计分析2015年1月至2016年1月大连市妇幼保健院新生儿ICU血培养临床资料并采用CRP检测试剂盒对血培养阳性的患者进行hs-CRP的检测。结果血培养阳性结果中,凝固酶阴性葡萄球菌46株,占65.7%,肺炎克雷伯菌8株,占11.4%,大肠埃希菌5株,占7.1%,肠杆菌、鲍曼不动杆菌、洛非不动杆菌各2株,分别占2.9%,摩根摩根菌、B群链球菌、金黄色葡萄球菌、肠球菌、微球菌各1株,分别占1.4%;hs-CRP的检出量,革兰阴性菌感染组为(20.60±3.40)mg/L,革兰阳性菌感染组为(15.80±2.30)mg/L,正常对照组为(4.10±0.95)mg/L。结论新生儿血培养阳性的主要致病菌为凝固酶阴性葡萄球菌、肺炎克雷伯菌和大肠埃希菌;有细菌感染的新生儿血中hs-CRP值升高,革兰阴性菌感染hs-CRP值高于革兰阳性菌。     

老年重症肺炎接受机械通气患者血清超敏C反应蛋白与短期预后的关系

目的:探讨老年重症肺炎接受机械通气患者血清超敏C反应蛋白(hs-CRP)与短期预后的关系。方法:将97例老年重症肺炎接受机械通气治疗的患者按照入院第28h的预后分为死亡组(n=34例)和存活组(n=63例),同时按照肺炎严重指数(PSI)和CURB-65评分将患者分为Ⅳ级组(90~130分)(n=29例)和V级组(130分)(n=68例);CURB-65评分2分组(n=31例)和CURB-65评分3~5分组(n=66例);比较各组患者相关临床指标、入院第1 d、3 d、7 d的血清hs-CRP水平的差异,分析血清hs-CRP水平与近期预后的关系。结果:死亡组与存活组患者在机械通气时间、CURB-65评分、PSI、血清白蛋白(ALB)、降钙素原(PCT)、血乳酸(Lac)方面存在统计学差异(P0.05);死亡组患者入院第1 d、3 d、7 d的血清hs-CRP水平显著高于死亡组(P0.05);PSI中V级组,CURB-65评分3~5分组中入院第1 d、3 d、7 d的血清hs-CRP水平亦高于Ⅳ级组和CURB-65评分2分组。血清hs-CRP水平是患者近期死亡的独立危险因素。入院后第1 d、3 d、7 d的血清hs-CRP水平患者死亡的ROCAUC分别为0.844、0.914、0.772,最佳诊断截点分别为51.76 mg/L、92.56 mg/L及49.38 mg/L。结论:血清hs-CRP水平是老年重症肺炎接受机械通气患者近期死亡的独立危险因素,动态检测血清hs-CRP变化对评估患者预后具有一定的临床意义。     

降钙素原和超敏C-反应蛋白在病毒和细菌感染早期鉴别中的临床应用

为探讨降钙素原(PCT)和超敏C-反应蛋白(hs-CRP)在病毒感染和细菌感染患者鉴别诊断中的价值,对我院276例患者,包括病毒感染组(64例)、细菌感染组(164例)和非感染组(48例)进行降钙素原和超敏C-反应蛋白水平的检测,并对三组间的差异进行分析。结果显示,细菌感染组和病毒感染组PCT、hs-CRP水平显著性高于非感染组(p<0.05);细菌感染组PCT、hs-CRP水平显著性高于病毒感染组(p<0.05)。工作特征曲线及Logistic回归分析结果显示,PCT在鉴别诊断细菌感染和病毒感染的效果高于hs-CRP。研究结果表明,降钙素原、超敏C-反应蛋白可对病毒感染和细菌感染进行早期的鉴别诊断,而降钙素原的效果较好。     

血栓通对急性脑梗塞患者血清D-二聚体和超敏C反应蛋白的作用

目的:观察血栓通对急性脑梗死(actue cerebral infarction,ACI)患者血清D-二聚体和超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)水平的影响。方法:将68例ACI患者随机分为观察组和对照组。两组进行常规治疗,观察组加用血栓通0.5 g/d,静滴。于治疗前、治疗后3 d、7 d和14 d检测患者血清D-二聚体和hs-CRP浓度变化,比较两组治疗前后改良爱丁堡-斯堪的纳维亚神经功能评分(MESSS)及日常生活能力Barthel指数(BI)的变化。结果:观察组在治疗后3 d、7 d和14 d,血清D-二聚体和hs-CRP浓度较对照组明显降低(P0.05),MESSS和BI评分在治疗后7 d和14 d较对照组明显改善(P0.05)。观察组的显效率和总有效率高于对照组(P0.05)。结论:血栓通可降低ACI患者血清D-二聚体和hs-CRP水平,改善神经功能,是一种有效治疗急性脑梗塞的方法。     

血清甘油三酯变化在急性缺血性脑卒中的临床意义

目的:探讨血清甘油三酯(TG)与急性缺血性脑卒中(AIS)早期预测之间的相关性.方法:我们收集了736例AIS患者.依据TG水平将患者分为5组.参照美国国立卫生研究院(为什么不参照我国的标准)卒中量表(NIHSS),将早期神经功能恶化(END)设定为≥4分,将新发症状开始一周后的早期临床改善(ECI)定为降低4分或以上.将各组内的END、ECI患者及两者都不是的患者进行比较.结果:高TG和低TG组患者发生END的风险显著高于正常组.高TG、低TG组以及临界组患者发生ECI的百分率显著低于正常组.多元回归分析显示高TG、低TG组以及临界组患者在END中的or值显著高于正常低值组(50-100 mg/dl).AIS患者的甘油三酯(TG)水平与预后不良呈非线性的J型相关,与良好预后呈反J形相关.结论:在AIS的早期高TG和低TG都是预后不良的危险因素.     

糖化血红蛋白水平与急性缺血性脑卒中预后的相关性

目的：探讨糖化血红蛋白对急性脑梗死患者病情严重程度及预后的影响,为临床治疗提供科学依据。方法：将106例合并糖尿病的急性脑梗死患者根据其入院48h内HbA1c水平分为3组,对3组进行神经功能缺损评分、脑梗死损伤程度、治疗后疗效评价比较。结果：治疗前A组和B组神经功能缺损评分均明显高于C组（P〈0.05）,治疗后各组较治疗前均有所降低,但A组和B组神经功能缺损评分仍明显高于C组（P〈0.05）;入院时A组和B组脑梗死损伤程度中度、重度者明显高于C组（P〈0.05）;总有效率A组和B组明显低于C组,且A组与B组比较,A组明显低于B组（P〈0.05）,A组和B组脑梗死急性期加重率和死亡率明显高于C组（P〈0.05）;A组与B组相比,A组神经功能缺损评分、脑梗死损伤程度以及急性期加重率和死亡率明显高于B组,总有效率较B组低（P〈0.05）。结论：HbA1c水平与脑卒中的严重程度以及急性期预后不良密切相关,可以作为反映脑卒中发病时病情严重的指标之一。值得推广。     

支气管哮喘急性发作期超敏C-反应蛋白、白细胞、中性粒细胞比例检测的意义及比较

探讨超敏C-反应蛋白（hs-CRP）、血白细胞总数（WBC）、中性粒细胞比例（N％）在支气管哮喘（简称哮喘）急性发作期诊治中的临床意义。方法：分析60例患者治疗前及自觉症状缓解时hs—CRP、WBC、N％动态变化情况,观察上述指标在急性发作期的阳性率以及自觉症状缓解时的阴性率。结果：①hs-CRP、N％、WBC在自觉症状缓解时均明显低于哮喘急性发作期（P〈0．05）;②哮喘患者急性发作期hs—CRP、N％阳性率均高于WBC阳性率,且与后者比较均具有统计学差异（P〈0．05）;③哮喘患者经治疗自觉症状缓解时hs-CRP、WBC阴性率均高于N％阴性率,且与后者比较均具有统计学差异（P〈0．05）。结论-血清hs-CRP既可作为哮喘患者急性发作期感染的敏感指标,又是反映急性发作期治疗效果的早期评判指标,比WBC、N％更迅速、敏感。     

血清唾液酸和超敏C反应蛋白与高血压前期的关系及临床意义

目的:探讨血清唾液酸(SA)和超敏C反应蛋白(hs-CRP)与高血压前期的关系及临床意义。方法:将160例2012年10月至2014年9月于我院进行体检者分为正常血压组、高血压前期组和高血压组,分别测量所有研究对象的血压、身高和体重,检测所有对象同一天的血清SA、hs-CRP、血清总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、三酰甘油(TG)和空腹血糖(FPG)水平,采用多元线性回归方法探究血清SA和hs-CRP水平对收缩压(SBP)和舒张压(DBP)的影响。结果:三组间的DBP、SBP、BMI、SA、hs-CRP、TC、LDL、HDL和FBG水平差异均具有统计学意义(P0.05),其中BMI、SA和hs-CRP水平随着血压升高逐渐上升,而HDL水平逐渐下降(P0.05);TC和LDL水平仅高血压组高于正常血压组,高血压前期组与正常血压组的TC和LDL水平差异无统计学意义(P0.05);多元线性回归发现:BMI、SA、hs-CRP和FBG均与SBP成正相关,BMI、SA、hs-CRP和LDL均与DBP呈正相关。结论:血清SA与hs-CRP水平均与血压值呈现独立正相关,可作为高血压前期的评估指标。     

Combination of High-Sensitivity C-Reactive Protein and Homocysteine Predicts the Post-Stroke Depression in Patients with Ischemic Stroke

In this study, we examined the changes in high-sensitivity C-reactive protein (Hs-CRP) and homocysteine (HCY) levels, two of the risk factors, during the acute period of ischemic stroke (IS) and evaluated the relationship between these two factors and long-term post-stroke depression (PSD). In this study, 259 patients with IS had finished the follow-up and were included. Based on the symptoms, diagnoses of depression were made in accordance with DSM-IV criteria for depression at 1 year after stroke. The influence of Hs-CRP/CHY levels on PSD was performed by binary logistic regression analysis and receiver operating characteristic curves (ROC). Totally, 94 out of the 259 patients were diagnosed as PSD (36.3%; 95% CI 30.4–42.1%). In multivariate logistic regression analysis, the third and fourth quartiles of Hs-CRP or HCY were significantly associated with PSD during the observation period compared to the first quartile group (P < 0.05). In addition, patients with depression were older and more frequently were female, living with offspring, widowhood, higher initial stroke severity, and BMI. HCY improved the ability of Hs-CRP [0.72 (95% CI 0.66–0.79)] to diagnose PSD (AUC of the combined model 0.76; 95% CI 0.69–0.82; P = 0.021). The patient group with higher levels of both Hs-CRP and HCY (> median) had an OR of 6.05 (95 % CI 3.13–10.15; P < 0.001) for PSD compared with patients with lower levels of both factors (< median). The data suggests that elevated serum levels of Hs-CRP and HCY were associated with the risk of developing PSD 1 year after the stroke onset, and those two factors combined to add prognostic information in the early evaluation of PSD.     

Genetic Variants in C-Reactive Protein and Ischemic Stroke Susceptibility

Considerable discrepancies in the previously reported associations of the C-reactive protein (CRP) gene variants and ischemic stroke (IS) risk prompted us to perform this meta-analysis. We selected the fixed effects Mantel–Haenszel method to estimate the risk of IS [OR (odds ratio) along with its 95 % CI (confidence interval)] in relation to the CRP variants (?717 A > G, 1444 C > T). Heterogeneity test, influence analysis and publication bias test were appropriately performed using respective methods. We analyzed 1,926 IS patients and 2,678 controls and found the ?717 A > G variant was not significantly associated with overall IS risk. Subsequent analysis of the 1444 C > T variant involving 3,278 samples similarly revealed no significant association with IS. There was no substantial heterogeneity or publication bias in this analysis. Our meta-analysis may provide first evidence showing that genetic variants within the CRP locus are unlikely to modulate risk of IS.     

High-Sensitivity C-Reactive Protein and Risk of Sepsis

Background

Conventional C-reactive protein assays have been used to detect or guide the treatment of acute sepsis. The objective of this study was to determine the association between elevated baseline high-sensitivity C-reactive protein (hsCRP) and the risk of future sepsis events.

Methods

We studied data from 30,239 community dwelling, black and white individuals, age ≥45 years old enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Baseline hsCRP and participant characteristics were determined at the start of the study. We identified sepsis events through review of hospital records. Elevated hsCRP was defined as values >3.0 mg/L. Using Cox regression, we determined the association between elevated hsCRP and first sepsis event, adjusting for sociodemographic factors (age, sex, race, region, education, income), health behaviors (tobacco and alcohol use), chronic medical conditions (coronary artery disease, diabetes, dyslipidemia, hypertension, chronic kidney disease, chronic lung disease) and statin use.

Results

Over the mean observation time of 5.7 years (IQR 4.5–7.1), 974 individuals experienced a sepsis event, and 11,447 (37.9%) had elevated baseline hsCRP (>3.0 mg/L). Elevated baseline hsCRP was independently associated with subsequent sepsis (adjusted HR 1.56; 95% CI 1.36–1.79), adjusted for sociodemographics, health behaviors, chronic medical conditions and statin use.

Conclusion

Elevated baseline hsCRP was associated with increased risk of future sepsis events. hsCRP may help to identify individuals at increased risk for sepsis.     

炎症标记物与缺血性中风预后评价

缺血性中风触发的炎症反应是一个级联放大过程,不仅可直接对缺血脑组织造成继发性损伤,还可通过与其他病理生理通路的相互影响、相互促进,共同对缺血后脑组织造成不可逆损伤。因此,采用炎症标记物对脑缺血损伤及其预后进行评价,具有重要临床意义。临床研究发现,多炎症标记物法用于缺血性中风的诊治和预后评价比单炎症标记物法更全面、更准确,故更具明显优势。综述脑缺血引发的炎症机制、脑缺血所致炎症通路与其他病理生理通路( 如氧化应激、细胞凋亡和兴奋性毒性) 的关联以及炎症标记物在缺血性中风预后评价中的应用。     

The Relationship Between Serum Mannose-Binding Lectin Levels and Acute Ischemic Stroke Risk

Complement activation and inflammation have been suggested in the pathogenesis of stroke, mannose-binding lectin (MBL) were found to have roles during the process. The aim of this study was to investigate the relationship between acute ischemic stroke (AIS) and serum MBL levels in Chinese population. From January 1 to June 30 2013, all patients with first-ever AIS were recruited to participate in the study. Serum MBL levels and routine test were examined. The National Institutes of Health Stroke Scale (NIHSS) score was assessed on admission blinded to MBL levels. During the inclusion period, 148 patients with AIS were registered and completed study. The results indicated that the serum MBL levels were significantly (p < 0.0001) higher in acutely ischemic stroke patients as compared to normal controls [1,332; interquartile range (IQR) 996–2,134 μg/L and 897; IQR 678–1,100 μg/L, respectively]. There was a correlation between serum levels of MBL and NIHSS score [r (spearman) = 0.608, p < 0.0001). In multivariate analysis, serum MBL as a continuous variable was associated with an increased risk of AIS, after adjustment for above possible confounders (OR 1.002, 95 % CI 1.001–1.008; p < 0.0001). These results indicated that elevated MBL levels could be considered as an independent stroke risk factor in Chinese population, suggesting a role of MBL and the lectin pathway of complement activation in the pathogenesis of stroke.