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目的研究急性缺血性脑血管病患者早期P-选择素动态变化与患者病情及预后的相关性。方法选取急性脑梗死患者发病在24 h内,表现为部分或完全前循环梗死,男26例,女14例,年龄37～78(55.14±10.23)岁;在患者入院时、24 h、48 h、72 h、7 d抽取静脉血,对照组为健康体检者采空腹静脉血。采用流式细胞技术测定血浆P-选择素;采用NIHSS评分评价患者发病时神经功能情况,以CSS评分评价患者4周后恢复情况。结果急性脑梗死患者血浆P-选择素水平在发病后24 h开始显著升高并达到高峰,48 h明显下降,7 d下降更显著,与对照组比较差异均有统计学意义(P<0.01,P<0.05);7 d P-选择素水平与自身24 h比较差异亦有统计学意义(P<0.01)。P-选择素峰值水平在中、重度神经功能缺损患者高于轻度神经功能缺损患者(P<0.05);在不同预后(治疗后进步与无变化)患者间无统计学差异(P>0.05)。结论急性脑梗死不同发病时间血浆P-选择素水平不同,在发病后24 h开始显著升高,并达到高峰,P-选择素表达可以作为判断患者病情的指标。
Objective To study the correlation between early P-selectin dynamic changes and patient’s condition and prognosis in patients with acute ischemic cerebrovascular disease. Methods The patients with acute cerebral infarction (ACI) within 24 hours were classified as partial or complete anterior circulation infarction. There were 26 males and 14 females, ranging in age from 37 to 78 (55.14 ± 10.23) years. At admission, 24 h, 48 h , 72 h, 7 d venous blood was drawn, the control group of healthy subjects were taken fasting venous blood. Plasma P-selectin was measured by flow cytometry. NIHSS score was used to evaluate the neurological function of patients at the onset of disease. CSS scores were used to evaluate the recovery of patients after 4 weeks. Results Plasma P-selectin levels in patients with acute cerebral infarction increased significantly and peaked 24 h after onset, decreased significantly at 48 h and decreased significantly at 7 d, with statistical significance (P <0.01, P <0.05). There was also a significant difference between the 7-day P-selectin level and the 24-hour P value (P <0.01). P-selectin peak level in patients with moderate or severe neurological deficit was significantly higher than that in patients with mild neurological deficit (P <0.05); there was no significant difference between patients with different prognosis (progression and no change after treatment) (P> 0.05) . Conclusions Plasma P-selectin levels are different at different stages of onset of acute cerebral infarction, and begin to increase significantly at 24 hours after onset and reach a peak. The expression of P-selectin can be used as an index to judge the patient’s condition.