[1]赵海燕a,李 源a,王 鹏b.卵圆孔未闭导致隐源性卒中患者血清cTn I，NSE水平检测及诊断价值研究[J].现代检验医学杂志,2025,40(01):158-162+168.[doi:10.3969/j.issn.1671-7414.2025.01.030]
　ZHAO Haiyana,LI Yuana,WANG Pengb.Detection and Diagnostic Value of Serum cTn I，NSE Levels in Patients with Cryptogenic Stroke with Patent Foramen Ovale[J].Journal of Modern Laboratory Medicine,2025,40(01):158-162+168.[doi:10.3969/j.issn.1671-7414.2025.01.030]
点击复制

卵圆孔未闭导致隐源性卒中患者血清cTn I，NSE水平检测及诊断价值研究()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第40卷
期数:
2025年01期
页码:
158-162+168
栏目:
论著
出版日期:
2025-01-15

文章信息/Info

Title:
Detection and Diagnostic Value of Serum cTn I，NSE Levels in Patients with Cryptogenic Stroke with Patent Foramen Ovale
文章编号:
1671-7414（2025）01-158-06
作者:
赵海燕a; 李 源a; 王 鹏b
（达州市中心医院 a. 神经内科；b. 心脏血管外科，四川达州 635000）
Author(s):
ZHAO Haiyana; LI Yuana; WANG Pengb
（a. Department of Neurology；b. Department of Cardiovascular Surgery， Dazhou Central Hospital，Sichuan Dazhou 635000，China）
关键词:
心肌钙蛋白I; 神经元特异性烯醇化酶蛋白; 卵圆孔未闭; 隐源性卒中
分类号:
R743.9；R446.11
DOI:
10.3969/j.issn.1671-7414.2025.01.030
文献标志码:
A
摘要:
目的 探究卵圆孔未闭（PFO）导致隐源性卒中患者血清心肌钙蛋白I（cTn I）、神经元特异性烯醇化酶（NSE）蛋白表达及诊断价值。方法 选取2020 年12 月～ 2022 年12 月达州市中心医院收治的PFO 患者108 例，根据患者是否导致隐源性卒中分为隐源性卒中组（卒中组，n=32）和非隐源性卒中组（未卒中组，n=76）。根据美国国立卫生研究院卒中量表(NIHSS）评估神经功能缺损程度，分为轻度组（<4 分，n=10）、中度组（4~15 分，n=15）和重度组（>15 分，n=7）。全自动生化分析仪检测所有患者纤维蛋白原（FIB）、C 反应蛋白（CRP）和丙氨酸氨基转移酶（ALT）水平。采用ELISA 检测血清中cTn I，NSE 水平。ROC 曲线分析血清cTn I，NSE 对PFO 导致隐源性卒中的诊断价值；Logistic 回归分析影响PFO 患者隐源性卒中发生的因素。结果 与未卒中组相比，卒中组患者FIB（3.20±0.36g/L vs 2.95±0.30g/L），CRP（73.58±7.43mg/L vs 62.52±7.11mg/L），ALT（68.58±6.82U/L vs 61.08±6.28U/L），cTn I（0.78±0.10ng/L vs 0.58±0.08ng/L）和NSE（37.52±3.82μg/L vs 30.35±3072μg/L）水平显著升高，差异具有统计学意义（t=3.722 ～ 10.994，均P ＜ 0.05）。与轻度组相比，中度组和重度组患者血清中cTn I，NSE 水平显著升高（t=5.891，7.177；3.458，4.105），重度组cTn I，NSE 水平显著高于中度组（t=2.474，1.336），差异具有统计学意义（均P<0.05）。二者联合诊断PFO 患者隐源性卒中发生的AUC(95%CI)为[0.981（0.962 ～ 1.000）]，高于cTn I[0.878（0.864 ～ 0.948）]，NSE[0.911（0.850-0.972）] 单独诊断（Z=8.621，6.477，均P ＜ 0.001）。Logistic 回归分析显示，cTn I（OR=2.631，95%CI：1.508 ～ 4.591），NSE（OR=2.841，95%CI：1.514 ～ 5.330）是PFO 患者隐源性卒中发生的影响因素（均P ＜ 0.05）。结论 PFO 患者导致隐源性卒中患者血清中cTn I，NSEl 水平显著升高，对PFO 患者发生隐源性卒中具有一定的诊断价值。
Abstract:
Objective To explore the expression and diagnostic value of serum cardiac troponin Ⅰ (cTn Ⅰ ) and neuronspecific enolase protein (NSE) in patients with cryptogenic stroke caused by patent foramen ovale (PFO). Methods A total of 108 patients with PFO admitted to Dazhou Central Hospital from December 2020 to December 2022 were selected and divided into 32 patients with cryptogenic stroke group (stroke group) and 76 patients with non-cryptogenic stroke group (non-stroke group) according to whether the patients caused cryptogenic stroke. According to the National Institutes of Health Stroke Scale (NIHSS), they were divided into mild group (< 4points, n=10), moderate group (4 ～ 15points, n=15) and severe group (> 15points, n=7). levels of fibrinogen (FIB), C-reactive protein (CRP), and alanine aminotransferase (ALT) were measured by an automatic biochemical analyzer in all patients. The serum levels of cTn I and NSE were detected by ELISA-diagnostic value of serum cTn I and NSE in PFO-induced cryptogenic stroke by ROC curve analysis. Logistic regression was applied to analyze the factors affecting the occurrence of cryptogenic stroke in PFO patients. Results Compared with the non-stroke group, the levels of FIB（3.20±0.36g/L vs 2.95±0.30g/L）, CRP（73.58±7.43mg/L vs 62.52±7.11mg/L）,ALT （68.58±6.82U/L vs 61.08±6.28U/L）, cTn I（0.78±0.10ng/L vs 0.58±0.08ng/L）and NSE（37.52±3.82μg/L vs 30.35±3.72μg/L）in the stroke group were increased, and the differences were statistically significant（t=3.722 ～ 10.994，all P<0.05）. Compared with the mild group, the levels of cTn I and NSE in the serum of patients in the moderate and severe groups were increased（t=5.891， 7.177；3.458，4.105），the levels of cTn I, NSE in the serum of the severe group were significantly higher than those in the moderate group (t=2.474, 1.336)， the differences were statistically significant （all P<0.05）．The AUC (95% CI) for the combined diagnosis of cryptogenic stroke in PFO patients was [0.981 (0.962 ～ 1.000)], which was higher than cTn I [0.878(0.864 ～ 0.948)]， NSE[0.911(0.850 ～ 0.972)] diagnosed alone (Z=8.621，6.477, all P<0.001). Logistic regression analysis showed that cTn I （OR=2.631，95%CI：1.508 ～ 4.591）, and NSE（OR=2.841，95%CI：1.514 ～ 5.330）were the influencing factors for the occurrence of cryptogenic stroke in PFO patients (P<0.05). Conclusion The serum levels of cTn I and NSE in patients with cryptogenic stroke caused by PFO patients are significantly increased, which has certain diagnostic value for patients with cryptogenic stroke.

参考文献/References:

[1] 徐楠, 许建萍, 房亚兰, 等.cTCD，cTTE，cTEE 对卵圆孔未闭右向左分流的诊断价值[J]．中西医结合心脑血管病杂志，2023,21(1):165-169． XU Nan, XU Jianping, FANG Yalan, et al. Diagnostic value of cTCD, cTTE and cTEE in right-to-left shunt of patent foramen ovale [J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2023, 21(1): 165-169.
[2] 郭慧敏，胡海波．卵圆孔未闭可能诱发脑卒中相关生化指标的研究进展[J]. 中国介入心脏病学杂志，2023,31(2):138-141． GUO Huimin, HU Haibo. Research progress of biochemical indexes related to patent foramen ovale induced stroke [J]. Chinese Journal of Interventional Cardiology, 2023, 31(2): 138-141.
[3] 李福荣，隋晓雯，张美艳，等．卵圆孔未闭分流量、解剖特点与隐源性脑卒中影像学特点的相关性[J].卒中与神经疾病，2022,29(4):324-329． LI Furong, SUI Xiaowen, ZHANG Meiyan, et al. Correlations between shunt flow，anatomical features of patent foramen ovale and imaging characteristics of cryptogenic stroke[J]. Stroke and Nervous Diseases, 2022, 29(4): 324-329.
[4] 李志宇，崔少华，耿立霞．生物标志物联合检测对脓毒性心肌损伤患者早期诊断及预后评估的价值[J]. 中华危重病急救医学，2021,33(4):443-448. LI Zhiyu, CUI Shaohua, GENG Lixia. Value of combined detection of biomarkers in early diagnosis and prognosis of patients with septic myocardial injury [J]. Chinese Critical Care Medicine, 2021, 33(4): 443-448.
[5] 沈海林，戴杰，朱向阳．急性缺血性脑卒中静脉溶栓患者血清肌钙蛋白I 水平与预后的关系[J]. 南通大学学报（医学版）,2022,42(2):171-175． SHEN Hailin, DAI Jie, ZHU Xiangyang. Relationship between serum troponin I level and prognosis of acute ischemic stroke patients with intravenous thrombolytic therapy[J]. Journal of Nantong University(Medical Sciences), 2022, 42(2): 171-175.
[6] 陈冬，姚成，高文仓，等．血清神经元特异性烯醇化酶、循环肿瘤细胞和乳酸脱氢酶水平在小细胞肺癌诊断及治疗中的价值[J]. 中国基层医药，2021,28(12):1809-1813． CHEN Dong, YAO Cheng, GAO Wencang, et al. Values of serum neuron-specific enolase,circulating tumor cells and lactate dehydrogenase levels in the diagnosis and treatment of small cell lung cancer [J]. Chinese Journal of Primary Medicine and Pharmacy, 2021, 28(12): 1809-1813.
[7] HAERTEL F, BABST J, BRUENING C, et al. Effect of hemolysis regarding the characterization and prognostic relevance of neuron specific enolase (NSE) after cardiopulmonary resuscitation with extracorporeal circulation (eCPR)[J]. Journal Clinical Medicine, 2023, 12(8): 3015.
[8] 中华医学会心血管内科分会．中国医师协会心血管内科分会. 卵圆孔未闭预防性封堵术中国专家共识[J]. 中国循环杂志，2017,32(3):209-214． Chinese Society of Cardiology, Chinese Medical Association，Cardiovascular Board of Chinese Medical Doctor Association. Chinese expert consensus on preventive closure of patent foramen ovale[J]. Chinese Circulation Journal, 2017, 32(3): 209-214.
[9] 中华医学会神经病学分会．中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]．中华神经科杂志，2018，51（9）：666-682． Chinese Society of Neurology，Chinese Stroke Society, Chinese Medical Association．Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]．Chinese Journal of Neurology，2018, 51(9): 666-682.
[10] 朱健，蔡坚，杨谨，等．血清神经元特异性烯醇化酶评估急性脑梗死患者病情严重程度及短期预后的意义[J]．中国医药导报，2023，20（8）：83-86． ZHU Jian, CAI Jian, YANG Jin, et al. Significance of serum neuron-specific enolase in evaluating severity and short-term prognosis of patients with acute cerebral infarction [J]. China Medical Herald, 2023, 20(8): 83-86.
[11] BADEA R ?, RIBIGAN A C, GRECU N, et al. Differences in clinical and biological factors between patients with PFO-related stroke and patients with PFO and no cerebral vascular events[J]. Frontiers in Neurology, 2023, 14: 1104674.
[12] HE Dan, SHI Qiang, XU Guangjing, et al. Clinical and infarction patterns of PFO-related cryptogenic strokes and a prediction model[J]. Annals of Clinical and Translational Neurology, 2018, 5(11): 1323-1337.
[13] 赵志宏，宋湘，王赛华，等．卵圆孔未闭伴心房颤动患者行左心耳联合卵圆孔未闭封堵安全性与有效性初探[J]．中华心血管病杂志，2022，50（3）：257-262． ZHAO Zhihong, SONG Xiang, WANG Saihua, et al. Safety and efficacy of left atrial appendage closure combined with patent foramen ovale closure for atrial fibrillation patients with patent foramen ovale [J]. Chinese Journal of Cardiology, 2022, 50(3): 257-262.
[14] 杨洋，徐彧，袁锦霞，等．血清miR-145,miR-150表达水平与急性心肌梗死患者PCI 术后心力衰竭的关系[J]. 国际检验医学杂志,2022,43(4):414-419. YANG Yang, XU Yu, YUAN Jinxia, et al. Relationship between serum miR-145 and miR-150 expression levels with heart failure after PCI in patients with acute myocardial infarction [J]. International Journal of Laboratory Medicine, 2022, 43(4): 414-419.
[15] 易福凌，陈伟芝，王禺．慢性心力衰竭患者血清Mb,cTnI,IL-8 和hs-CRP 水平表达与心功能分级的相关性研究[J]．现代检验医学杂志,2021,36(3):58-61, 67. YI Fuling, CHEN Weizhi, WANG Yu. Correlation between the expression of serum MB,cTnI,IL-8,hs-CRP and cardiac function in patients with chronic heart failure [J]. Journal of Modern Laboratory Medicine, 2021, 36(3): 58-61, 67.
[16] 邓彩英．麻醉诱导前负荷剂量右美托咪定静注及术中持续泵注对冠心病择期非心脏手术患者血清cTnI，GP-BB 水平的影响[J]．现代中西医结合杂志，2019,28(11):1220-1224． DENG Caiying. Effects of anesthesia induced preload dose dexmedetomidine intravenous injection and intraoperative continuous pumping on serum cTnI and GP-BB levels in patients with coronary heart disease undergoing elective non-cardiac surgery[J].Modern Journal of Integrated Traditional Chinese and Western Medicine, 2019, 28(11): 1220-1224.
[17] POLYAKOVA M, MUELLER K, ARELIN K, et al. Increased serum NSE and S100B indicate neuronal and glial alterations in subjects under 71 years with mild neurocognitive disorder/mild cognitive impairment [J]. Frontiers in Cellular Neuroscience, 2022, 16: 788150.
[18] HAQUE A, POLCYN R, MATZELLE D, et al. New insights into the role of Neuron-Specific enolase in Neuro-Inflammation, neurodegeneration, and neuroprotection[J]. Brain Sciences, 2018, 8(2): 33.
[19] 郭娜，马英, 王琳莹，等．脑卒中患者血清Hcy 及NSE 水平与癫痫发作的相关性研究[J]. 现代检验医学杂志，2022,37(1):177-181． GUO Na, MA Ying, WANG Linying, et al. Correlation between serum Hcy，NSE levels and epileptic seizures in patients with stroke[J]. Journal of Modern Laboratory Medicine, 2022, 37(1): 177-181.
[20] 胡明洁，张凤英，刘慧影．超敏cTnT 与血栓-炎症因子的相关性及其对急性缺血性脑卒中神经功能结局的预测价值[J]. 新医学，2021,52(3):203-207． HU Mingjie, ZHANG Fengying, LIU Huiying. Relationship between high-sensitivity cardiac troponin T and thrombo-inflammatory molecules and its value in predicting neurological function outcome after acute ischemic stroke [J]. Journal of New Medicine, 2021, 52(3): 203-207.
[21] 周让．急性缺血性脑卒中患者的血清神经元特异性烯醇化酶及淀粉样蛋白A,C- 反应蛋白水平与脑损伤、梗死程度的相关性分析[J]. 现代医学与健康研究电子杂志，2023,7(3):93-96． ZHOU Rang. Correlation analysis of serum levels of neuron-specific enolase,amyloid A and C-reactive protein with brain injury and infarction degree in patients with acute ischemic stroke[J]. Modern Medicine and Health Research, 2023, 7(3): 93-96.
[22] 刘君，蒋永明，严明生，等．血清NSE，SF 及SP水平与高血压脑出血术后转归的关系分析[J]. 解放军预防医学杂志，2020,38(3):59-61． LIU Jun, JIANG Yongming, YAN Mingsheng, et al. Relationship between serum NSE,SF and SP levels and outcome after hypertensive cerebral hemorrhage[J]. Journal of Preventive Medicine of Chinese People’s Liberation Army, 2020, 38(3): 59-61.

备注/Memo

备注/Memo:
基金项目：四川省卫生健康委员会医学科技项目（项目编号：21PJ198）。
作者简介：赵海燕（1978-）女，硕士，副主任医师，研究方向：脑血管病，E-mail:dz13508259116@163.com。
更新日期/Last Update: 2025-01-15