韩增灿

【摘要】 目的：探討青年急性脑梗死患者的血清中Hcy、VEGF、CRP和YKL-40水平变化情况，分析它们与青年急性脑梗死患者的病情及近期预后情况的关系。方法：收集本院于2018年4月-2020年4月收治的68例青年急性脑梗死患者为试验组，另选取同期来院体检的无急性脑梗死的68名健康者作为对照组。分析两组血清Hcy、VEGF、CRP和YKL-40水平。分析试验组患者血清Hcy、VEGF、CRP和YKL-40的水平变化与斑块性质（不稳定斑块、稳定斑块和无斑块）、神经功能损伤的程度、脑梗死灶的体积（大梗死病灶、中梗死病灶、小梗死病灶）以及近期预后（好转、未好转）的关系。结果：试验组患者血清Hcy、CRP、YKL-40水平及VEGF水平均高于对照组，差异均有统计学意义（P<0.05）。不稳定斑块组、稳定斑块组和无斑块组血清Hcy、VEGF、CRP和YKL-40水平比较，差异均有统计学意义（P<0.05）;不稳定斑块组、稳定斑块组患者血清Hcy、CRP和YKL-40水平均高于无斑块组，且不稳定斑块组上述指标均高于稳定斑块组，差异均有统计学意义（P<0.05）。血清Hcy、VEGF、CRP和YKL-40水平随着神经功能受损严重程度增加而升高，差异均有统计学意义（P<0.05）。血清Hcy、VEGF、CRP和YKL-40水平随着梗死灶体积增加而升高，差异均有统计学意义（P<0.05）。好转组血清Hcy、CRP和YKL-40水平均明显低于未好转组，而VEGF高于未好转组（P<0.05）。Hcy、CRP和YKL-40为近期预后的危险因素，VEGF为近期预后的保护因素（P<0.05）。结论：青年急性脑梗死患者血清Hcy、CRP、VEGF以及YKL-40水平可以作为评价急性脑梗死患者的病情和近期预后的指标。

【关键词】 急性脑梗死 同型半胱氨酸 C反应蛋白 血管内皮生长因子 甲壳质酶蛋白 预后

Changes of Serum Levels of Hcy， VEGF， CRP and YKL-40 in Young Patients with Acute Cerebral Infarction and Their Relationship with Prognosis/HAN Zengcan. //Medical Innovation of China， 2021， 18（13）： 0-072

[Abstract] Objective： To investigate the changes of serum levels of Hcy， VEGF， CRP and YKL-40 in young patients with acute cerebral infarction， and to analyze the relationship between them and the condition and short-term prognosis of young patients with acute cerebral infarction. Method： A total of 68 young patients with acute cerebral infarction admitted to our hospital from April 2018 to April 2020 were selected as the experimental group， and 68 healthy subjects without acute cerebral infarction who were admitted to our hospital for physical examination during the same period were selected as the control group. The serum levels of Hcy， VEGF， CRP and YKL-40 of two groups were analyzed. The relationship between the changes of serum Hcy， VEGF， CRP and YKL-40 levels and the nature of plaque （unstable plaque， stable plaque and non plaque）， the degree of neurological impairment， the volume of cerebral infarction （large infarction， medium infarction， small infarction） and the short-term prognosis （improved or non-improved） were analyzed. Result： The serum levels of Hcy， CRP， YKL-40 and VEGF in experimental group were higher than those in control group， the differences were statistically significant （P<0.05）. Serum levels of Hcy， VEGF， CRP and YKL-40 in unstable plaque group， stable plaque group and non-plaque group were compared， the differences were statistically significant （P<0.05）. Serum Hcy， CRP and YKL-40 levels in the unstable plaque group and the stable plaque group were higher than those in the non-plaque group， and the above indexes in the unstable plaque group were higher than those in the stable plaque group， the differences were statistically significant （P<0.05）. Serum levels of Hcy， VEGF， CRP and YKL-40 increased with the severity of neurological impairment， the differences were statistically significant （P<0.05）. Serum levels of Hcy， VEGF， CRP and YKL-40 increased with the increase of infarct volume， the differences were statistically significant （P<0.05）. The serum levels of Hcy， CRP and YKL-40 in improved group were significantly lower than those in non-improved group， while VEGF was higher than that of non-improved group （P<0.05）. Hcy， CRP and YKL-40 were risk factors for short-term prognosis， while VEGF was a protective factor for short-term prognosis （P<0.05）. Conclusion： Serum levels of Hcy， CRP， VEGF and YKL-40 in young patients with acute cerebral infarction can be used as indicators to evaluate the severity and short-term prognosis of patients with acute cerebral infarction.

[Key words] Acute cerebral infarction Homocysteine C-reactive protein Vascular endothelial growth factor Chitinase protein Prognosis

First-authors address： Juancheng County Peoples Hospital， Juancheng 274600， China

doi：10.3969/j.issn.1674-4985.2021.13.017

腦梗死即缺血性脑卒中，是脑血管疾病中的常见病和高发病[1]。具有发病率、致残率、致死率以及复发率高等特点[2]。通过近年来的临床研究发现，我国急性脑梗死的发病率逐年攀升，且呈现年轻化的趋势[3]。这不仅威胁人民的寿命和健康，更是为家庭和社会带来了严重的精神和经济负担。目前比较公认的脑梗死病机是动脉粥样硬化斑块的形成[4]。当然，众多研究也表明除去脂质代谢的异常外，炎症因子的出现也对斑块的形成和进展有重要意义[5]。血清同型半胱氨酸（homocysteine， Hcy）参与多种疾病发病过程，更被认为是脑梗死发病的独立危险因素之一[6]。C反应蛋白（C-reactive protein， CRP）是由肝细胞合成的急性时相反应蛋白，被认为是一种重要的急性炎症的血清标志物[7]。……