目的 探讨血清钙调蛋白(CAM)、血清生长分化因子(GDF)-15、血清氧化型低密度脂蛋白(ox-LDL)在急性缺血性脑卒中患者中的变化及其与神经功能的关系.方法 80例急性缺血性脑卒中患者按照入院时美国国立卫生研究院脑卒中量表(NIHSS)评分分为A组(≤15分)和B组(>15分),各40例,另选择同期体检的健康志愿者40例作为对照组.比较血清CAM、GDF-15、ox-LDL的水平,并分析其与NIHSS评分的相关性,应用Logistic回归分析急性缺血性脑卒中的危险因素并应用受试者工作特征(ROC)曲线分析CAM、GDF-15、ox-LDL及联合检测诊断急性缺血性脑卒中的效能.结果 A组、B组及对照组血清CAM分别为(235.26±61.85)ng/ml、(152.62±31.36)ng/ml、(87.85±22.32)ng/ml,差异有统计学意义(P<0.05);A组、B组及对照组血清GDF-15分别为(967.22±75.28)pg/ml、(648.14±50.26)pg/ml、(417.14±47.03)pg/ml,差异有统计学意义(P<0.05);A组、B组及对照组血清ox-LDL分别为(516.35±122.38)mg/L、(420.47±75.04)mg/L、(332.58±68.23)mg/L,差异具有统计学意义(P<0.05);A组、B组及对照组NIHSS评分分别为(23.25±3.36)分、(12.73±2.28)分、(1.05±0.69)分,差异具有统计学意义(P<0.05);急性缺血性脑卒中血清CAM、GDF-15、ox-LDL与NIHSS评分均呈正相关(r=0.517、0.851、0.338,均P<0.05);联合检测诊断效能(AUC=0.956,95% CI:0.913~0.998)明显高于CAM(AUC=0.824,95% CI:0.731~0.918)、GDF-15(AUC=0.876,95% CI:0.800~0.952)和ox-LDL(AUC=0.709,95% CI:0.594~0.824).结论 血清CAM、GDF-15、ox-LDL水平在急性缺血性脑卒中患者中明显增高,且与NIHSS评分均呈正相关,可作为判定病情严重程度的重要指标,且3种指标联合检测对于急性缺血性脑卒中更具有重要意义.%Objective To study the changes of serum calmodulin (CAM),serum growth factor(GDF)-15 and serum oxidized low density lipoprotein (ox-LDL) in patients with acute ischemic stroke and its relationship with neurological function relationship.Methods Retrospective analysis from January 2016 to December 2016 admissions of acute ischemic stroke patients,according to the admission NIHSS score was divided into group A and B group,40 cases,the other selected in the same period for physical examination of healthy volunteers in 40 cases as a control group. Then CAM, GDF-15, ox-LDL were compared and to analyze its correlation with NIHSS score of neurological function,Logistic regression analysis was used to analyze the risk factors of cerebral infarction. ROC curve analysis was used to analyze the diagnostic efficacy of CAM,GDF-15,ox-LDL and combined detection in diagnosis of cerebral infarction.Results The levels of serum CAM in group A,group B and control group were(235.26±61.85) ng/ml,(152.62 ± 31.36) ng/ml,(87.85±22.32) ng/ml,the differences were statistically significant(P<0.05). The levels of serum GDF-15 in group A,group B and control group were(967.22±75.28) pg/ml, (648.14 ± 50.26) pg/ml,(417.14±47.03) pg/ml,the differences were statistically significant (P<0.05). The levels of serum ox-LDL in group A,group B and control group were (516.35±122.38) mg/L,(420.47±75.04) mg/L,(332.58±68.23) mg/L,the differences were statistically significant(P<0.05). The scores of NIHSS in group A,group B and control group were(23.25 ± 3.36),(12.73±2.28) and (1.05 ± 0.69) respectively, the differences were statistically significant (P<0.05). There was a positive correlation between serum CAM,GDF-15,ox-LDL and NIHSS scores (r= 0.517,0.851,0.338,P<0.05);The diagnostic efficacy of combined diagnosis of cerebral infarction (AUC=0.956,95% CI:0.913~0.998) was higher than that of CAM(AUC = 0.824,95% CI 0.731~0.918),GDF-15(AUC=0.876,95% CI:0.800~0.952)and ox-LDL(AUC=0.709,95% CI:0.594~0.824).Conclusions Serum levels of CAM, GDF-15 and ox-LDL are significantly higher in patients with acute ischemic stroke and were positively correlated with NIHSS scores,which could be used as an important index to determine the severity of the disease,and the combined detection of three indexes is more important for acute ische-mic stroke.
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