Relationships of serum soluble triggering receptor expressed on myeloid cells-2, P-selectin and length of hyperdense middle cerebral artery sign with effect of thrombolysisand short-term prognosis in patients with acute cerebral infarction
-
摘要:目的
分析急性脑梗死(ACI)患者血清可溶性髓样细胞触发受体2(sTREM2)、P-选择素及大脑中动脉高密度征(HMCAS)长度与溶栓效果及近期预后的关系。
方法将109例ACI行溶栓治疗患者根据溶栓效果分为无效组(n=27)和有效组(n=82)。治疗后90 d，根据改良Rankin评分(mRS)将109例患者分为预后良好组(n=78)和预后不良组(n=31)。比较2组患者的一般资料、美国国立卫生研究院卒中量表(NIHSS)、血清sTREM2水平、P-选择素水平及HMCAS长度。应用二元Logistic回归模型分析ACI患者溶栓治疗效果的影响因素; 采用Pearson相关系数分析实验室指标与ACI患者mRS的相关性; 绘制受试者工作特征(ROC)曲线分析血清sTREM2、P-选择素及HMCAS长度对患者预后的预测价值。
结果有效组入院时NIHSS评分低于无效组，差异有统计学意义(P < 0.01)。有效组血清sTREM2、P-选择素水平低于无效组, HMCAS长度短于无效组，差异均有统计学意义(P < 0.01)。二元Logistic回归分析结果显示, NIHSS评分>15分(OR=2.649，95%CI: 1.357~5.167)、血清sTREM2水平高于均值(OR=2.686, 95%CI: 1.860~8.786)、P-选择素水平高于均值(OR=4.043, 95%CI: 1.860~8.786)以及HMCAS长度>1 mm(OR=3.827, 95%CI: 1.740~8.414)均为ACI患者溶栓治疗效果不佳的危险因素(P < 0.01)。预后良好组血清sTREM2、P-选择素水平低于预后不良组, HMCAS长度短于预后不良组，差异均有统计学意义(P < 0.01)。血清sTREM2、P-选择素及HMCAS长度与ACI患者溶栓治疗后mRS均呈正相关(r=0.686、0.597、0.662, P均 < 0.001)。血清sTREM2、P-选择素、HMCAS长度及3项指标联合预测ACI患者溶栓治疗预后的曲线下面积(AUC)分别为0.833、0.862、0.889、0.914, 敏感度分别为0.806、0.742、0.806、0.742, 特异度分别为0.923、0.897、0.936、0.949。
结论ACI患者溶栓治疗效果与入院时NIHSS评分、血清sTREM2水平、P-选择素水平及HMCAS长度有关，高水平血清sTREM2、P-选择素水平及长HMCAS可能增加ACI患者溶栓治疗效果不佳的风险。
Abstract:ObjectiveTo analyze the relationships of serum soluble triggering receptor expressed on myeloid cells-2 (sTREM2), P-selectin and the length of hyperdense middle cerebral artery sign (HMCAS) with the effect of thrombolysis and short-term prognosis in patients with acute cerebral infarction (ACI).
MethodsA total of 109 ACI patients with thrombolytic therapy were divided into ineffective group (n=27) and effective group (n=82) based on thrombolysis outcomes. Ninety days after treatment, the 109 patients were further divided into good prognosis group (n=78) and poor prognosis group (n=31) according to the modified Rankin Scale (mRS). General information, the National Institutes of Health Stroke Scale (NIHSS) score, serum sTREM2 level, P-selectin levels, and HMCAS length were compared between the two groups. Binary Logistic regression model was used to analyze the influencing factors of thrombolysis outcomes in ACI patients. Pearson correlation coefficient was calculated to analyze the correlation between laboratory indicators and mRS in ACI patients. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive values of serum sTREM2, P-selectin and HMCAS length for prognosis of patients.
ResultsThe NIHSS score at admission in the effective group was significantly lower than that in the ineffective group (P < 0.01). The serum sTREM2 and P-selectin levels as well as the HMCAS length in the effective group were significantly lower or shorter than those in the ineffective group (P < 0.01). The results of binary Logistic regression analysis showed that NIHSS score>15 (OR=2.649, 95%CI, 1.357 to 5.167), serum sTREM2 above the mean level (OR=2.686, 95%CI, 1.860 to 8.786), P-selectin above the mean level (OR=4.043, 95%CI, 1.860 to 8.786), and HMCAS length >1 mm (OR=3.827, 95%CI, 1.740 to 8.414) were all risk factors for poor thrombolysis outcomes in ACI patients (P < 0.01). The serum sTREM2 and P-selectin levels as well as the HMCAS length in the good prognosis group were significantly lower or shorter than those in the poor prognosis group (P < 0.01). Serum sTREM2, P-selectin and HMCAS length were all positively correlated with mRS in ACI patients after thrombolytic therapy (r=0.686, 0.597, 0.662, P < 0.001). Areas under the curve (AUCs) for predicting the prognosis of ACI patients after thrombolytic therapy by serum sTREM2, P-selectin, HMCAS length, and the combination of the three indicators were 0.833, 0.862, 0.889 and 0.914 respectively, with sensitivities of 0.806, 0.742, 0.806 and 0.742 respectively, and specificities of 0.923, 0.897, 0.936 and 0.949, respectively.
ConclusionThe effect of thrombolysis in ACI patients is related to NIHSS score at admission, serum sTREM2 level, P-selectin level, and HMCAS length. High levels of serum sTREM2 and P-selectin and a long HMCAS may increase the risk of poor thrombolysis outcomes in ACI patients.
-
-
表 1 有效组与无效组一般资料比较(x±s)[n(%)]
一般资料 分类 有效组(n=82) 无效组(n=27) χ2/t P 性别 男 46(56.10) 15(55.56) 0.002 0.961 女 36(43.90) 12(44.44) 年龄/岁 63.74±5.33 65.28±4.97 1.323 0.189 BMI/(kg/m2) 22.31±2.78 21.98±3.02 0.534 0.602 合并症 糖尿病 8(9.76) 4(14.81) 0.080 0.961 高血压 5(6.10) 3(11.11) 高血脂 3(3.66) 2(7.41) 病灶数 单一病灶 51(62.20) 16(59.26) 0.074 0.786 多发病灶 31(37.80) 11(40.74) 入院时NIHSS评分/分 11.36±2.61 13.96±2.97 4.337 < 0.001 BMI: 体质量指数; NIHSS: 美国国立卫生研究院卒中量表。 
下载: 导出CSV
表 2 2组实验室指标比较(x±s)
指标 有效组(n=82) 无效组(n=27) sTREM2/(ng/L) 223.36±21.14** 291.15±25.12 P-选择素/(ng/L) 22.87±4.14** 28.15±4.32 HMCAS长度/mm 0.73±0.18** 1.26±0.31 sTREM2: 血清可溶性髓样细胞触发受体2;
HMCAS: 大脑中动脉高密度征。与无效组比较, **P < 0.01。
下载: 导出CSV
表 3 变量赋值
变量 赋值 溶栓治疗效果 无效=1, 有效=0 NIHSS评分 >15分=1, ≤15分=0 sTREM2 >均值=1, ≤均值=0 P-选择素 >均值=1, ≤均值=0 HMCAS长度 >1 mm=1, ≤1 mm=0
下载: 导出CSV
表 4 影响ACI患者溶栓治疗效果情况的多因素分析
变量 β SE Wald χ2 OR 95%CI P 入院时NIHSS评分 0.974 0.341 8.158 2.649 1.357~5.167 0.004 sTREM2 1.024 0.356 8.274 2.686 1.860~8.786 0.004 P-选择素 1.421 0.413 11.838 4.043 1.860~8.786 0.001 HMCAS长度 1.342 0.402 11.144 3.827 1.740~8.414 0.001
下载: 导出CSV
表 5 预后良好组与预后不良组血清sTREM2、P-选择素及HMCAS长度比较(x±s)
指标 预后良好组(n=78) 预后不良组(n=31) sTREM2/(ng/L) 225.39±14.20** 287.14±15.33 P-选择素/(ng/L) 23.98±2.03** 27.14±2.11 HMCAS长度/mm 0.81±0.12** 1.14±0.23 sTREM2: 血清可溶性髓样细胞触发受体2; HMCAS: 大脑中动脉高密度征。与预后不良组比较, **P < 0.01。
下载: 导出CSV
表 6 血清sTREM2、P-选择素及HMCAS长度对ACI患者溶栓治疗预后的预测效能
变量 AUC P 95%CI 敏感度 特异度 截断值 约登指数 sTREM2 0.833 < 0.001 0.738~0.949 0.806 0.923 271.19 ng/L 0.529 P-选择素 0.862 < 0.001 0.561~0.792 0.742 0.897 26.41 ng/L 0.639 HMCAS长度 0.889 < 0.001 0.799~0.979 0.806 0.936 1.09 mm 0.742 3项指标联合 0.914 < 0.001 0.857~0.971 0.742 0.949 — 0.691
下载: 导出CSV
-
[1] 范晓雪, 王超, 于琦莉, 等. 老年急性脑梗死患者血清Hcy、IMA水平与神经功能缺损程度和预后的关系[J]. 川北医学院学报, 2023, 38(4): 470-473. [2] 周娟, 陈娇, 王娟. 天麻素注射液联合静脉溶栓治疗急性脑梗死疗效及对患者氧化应激指标、血清炎症因子水平影响研究[J]. 创伤与急危重病医学, 2023, 11(4): 278-281. [3] 沈永玲, 朱海暴, 李勇, 等. CTA结合CTP对预测急性脑梗死患者静脉溶栓预后的价值[J]. 川北医学院学报, 2020, 35(2): 280-282. [4] 董屹, 鲍勇, 胡承志, 等. 重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死预后影响因素及血清胱抑素C水平对预后预测价值[J]. 临床军医杂志, 2023, 51(4): 404-407. [5] 周有婷, 李志鹏, 王嘉鹏. 急性脑梗死患者血清CTRP-3、D-二聚体、sTREM2水平及相关临床特征与溶栓后出血性转化的关系[J]. 中国现代医学杂志, 2023, 33(24): 60-66. [6] 玄洪雷, 啜红斐, 李珊珊, 等. 血小板—纤维蛋白凝块强度、P-选择素与急性脑梗死患者复发的相关性及其预测价值[J]. 疑难病杂志, 2021, 20(10): 1008-1011, 1016. [7] 马松华, 张玲玲, 陆健美, 等. 大脑中动脉高密度征长度对急性脑梗死静脉溶栓再通率及疗效的预测价值[J]. 重庆医学, 2022, 51(9): 1478-1481, 1486. [8] 周志远, 赵瑞雅. Solitaire AB支架机械介入取栓术联合溶栓治疗急性脑梗死的临床效果及预后研究[J]. 贵州医药, 2021, 45(2): 208-209. [9] KAZI S A, SIDDIQUI M, MAJID S. Stroke outcome prediction using admission nihss in anterior and posterior circulation stroke[J]. J Ayub Med Coll Abbottabad, 2021, 33(2): 274-278.
[10] 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. doi: 10.3760/cma.j.issn.1006-7876.2018.09.004 [11] HAGGAG H, HODGSON C. Clinimetrics: modified rankin scale (mRS)[J]. J Physiother, 2022, 68(4): 281. doi: 10.1016/j.jphys.2022.05.017
[12] 车静, 蔡耘, 刘娜, 等. 急性脑梗死患者血糖波动与NIHSS评分、mRS评分及血清炎症因子水平的相关性研究[J]. 老年医学与保健, 2022, 28(1): 92-97. [13] LIU L, LUO G Q, LIU Q, et al. Hemorrhagic risk factors after rt PA thrombolysis in acute cerebral infarction[J]. Eur Rev Med Pharmacol Sci, 2023, 27(12): 5542-5551.
[14] WEN H J, LV M K. Correlation analysis between serum procalcitonin and infarct volume in young patients with acute cerebral infarction[J]. Neurol Sci, 2021, 42(8): 3189-3196. doi: 10.1007/s10072-020-04856-x
[15] KWON H S, LEE E H, PARK H H, et al. Early increment of soluble triggering receptor expressed on myeloid cells 2 in plasma might be a predictor of poor outcome after ischemic stroke[J]. J Clin Neurosci, 2020, 73: 215-218. doi: 10.1016/j.jocn.2020.02.016
[16] 董汉宁, 彭芸娟, 雷国奇, 等. 急性缺血性脑卒中患者血清sTREM2和DKK-1水平检测对抑郁发生的预测价值研究[J]. 现代检验医学杂志, 2023, 38(6): 136-141. [17] 马婷婷, 张正学, 胡鸿炜, 等. 血清和脑脊液中sTREM2对预测急性缺血性脑卒中严重程度、出血转化和患者预后的临床价值[J]. 东南大学学报: 医学版, 2022, 41(1): 70-76. [18] 李玉玉, 许力, 马博, 等. 血清可溶性髓样细胞触发受体2与脑小血管病的相关性研究[J]. 蚌埠医学院学报, 2023, 48(8): 1060-1064. [19] 赵立伟, 李芳. 替罗非班联合丁苯酞治疗进展性脑卒中对患者P-selectin、CD63、CD62p水平及预后的影响[J]. 陕西医学杂志, 2021, 50(1): 89-92. [20] 孟灿灿, 程燕, 焦丽艳, 等. P-选择素和血栓素B2表达水平对不同部位缺血性脑卒中患者疗效及预后的影响研究[J]. 中国全科医学, 2022, 25(14): 1736-1740. [21] 史苏娜, 梁日晶, 贾相科, 等. 血清可溶性细胞间黏附分子1、E-选择素、P-选择素预测急性心肌梗死介入术后患者主要不良心血管事件发生的应用价值[J]. 心脑血管病防治, 2022, 22(1): 43-46. [22] 郑建新, 王洵, 王丹杰. 尿激酶静脉溶栓治疗伴有大脑中动脉高密度征急性脑梗死病人的疗效分析[J]. 中西医结合心脑血管病杂志, 2019, 17(19): 3037-3040. [23] 边丽, 张秀梅, 李妍, 等. 急性脑梗塞患者溶栓后END发生风险预测模型的构建及急救优化方案的预防效果[J]. 中国实验诊断学, 2023, 27(6): 631-637. [24] 黄文磊, 吴雯菁, 姜亦伦. 多模态CT大脑中动脉高密度征对急性缺血性脑卒中出血转化的预测价值的探讨[J]. 医学影像学杂志, 2022, 32(6): 919-923. [25] 李鑫, 李琼莉, 王军伟, 等. 急性缺血性脑卒中静脉溶栓后出血转化的多因素联合预测模型研究[J]. 中华老年心脑血管病杂志, 2021, 23(4): 430-432.
计量
- 文章访问数: 49
- HTML全文浏览量: 4
- PDF下载量: 6
苏公网安备 32100302010246号