作者：张磊 刘广琴 滕继军 张晨
【摘要】 目的 探讨超敏C反应蛋白(HsCRP)在不同病因所致的脑梗死病人中的水平变化及其在病因诊断中的价值。方法 选择急性脑梗死病人，通过记录病史及相关辅助检查，按照TOAST以及改良的TOAST病因分型方法进行分类，并比较两种分型方法各型的构成比及各型病人的HsCRP水平。结果 急性脑梗死病人按照TOAST分型，以LAA型最多(39.4%)，然后依次为SAD型(30.9%)、SUD型(23.9%)、CE型(3.9%)，SOD型最少(1.9%);按照改良TOAST分型，AT型最多(58.3%), 然后依次为SAD型(21.6%)、SUD型(15.1%)、CE型(3.1%)、SOD型(1.9%)。改良后方法使SUD型减少，AT型显著增多。两种分型方法的各型病人HsCRP水平明显高于对照组(F=27.64、25.32，q=4.06～12.61,P<0.01)，在脑梗死中以CE型HsCRP水平最高，显著高于其他各型，LAA型或AT型显著高于SAD型(q=2.90～9.27,P<0.05、0.01)。结论 改良的TOAST病因分型能较全面地对脑梗死进行分型，减少不明原因的脑梗死病人。HsCRP水平在不同病因的脑梗死中明显不同，可作为脑梗死病因分型的依据之一。
【关键词】 脑梗死;C反应蛋白;病因学;分型
[ABSTRACT] Objective To detect the levels of high sensitivity Creactive protein (HsCRP) and its value in etiological diagnosis for differentcause cerebral infarction (CI). Methods Acute patients with CI were selected, their history and auxiliary examinations recorded, etiologic typing was carried out based on TOAST and modified TOAST. The constituent ratio of the two typing methods and HsCRP levels of different type patients were compared. Results TOAST method, the most popular type of acute CI was LAA (39.4%), followed by SAD (30.9%), SUD (23.9%), CE (3.9%) and SOD (1.9%); According to the modified TOAST, the most popular type was AT (58.3%), came next were SAD (21.6%), SUD (15.1%), CE (3.1%) and SOD(1.9%). With the modified method, types of unknown causes decreased, and type AT increased. The levels of HsCRP in patients of different types classified by two TOAST methods were markedly higher than that of the control (P<0.01). In CI, the levels of HsCRP were the highest in type CE, and type LAA or AT was manifestly higher than SAD (P<0.05). Conclusion The modified TOAST etiological typing may comparatively and roundly classify CI, reduce the number of CI patients with unknown causes. The levels of HsCRP are obviously different in patients of various origins, which can be used as one of the evidences for etiological grouping of CI.
[KEY WORDS] cerebral infarction; Creactive protein; etiology; typing
缺血性脑卒中的病因复杂，对其进行病因分型，并根据分型进行分层治疗是防治缺血性脑卒中的重要手段[12]。超敏C反应蛋白(HsCRP)是第一个被发现的机体急性时相反应蛋白，可以刺激血管内皮细胞分泌黏附分子，激活补体家族，促进吞噬细胞摄取低密度脂蛋白，促进血小板的聚集等，在加重炎症反应及斑块破裂甚至促发局部血栓形成过程中起一定的作用。本研究将急性脑梗死(ACI)病人分别按照TOAST和改良的TOAST病因分型标准[3]进行分型，比较两种病因分型方法各型的构成比及各型ACI病人的血清HsCRP水平，旨在探讨HsCRP在ACI病因学分型中的价值，从而为临床上不同病因ACI病人的诊断和治疗提供依据。
