摘要
目的探讨25-羟维生素D联合尿酸对缺血性脑卒中患者病情严重程度及早期预后的评估价值。方法选取2015-07—2016-06就诊的缺血性脑卒中患者166例为病例组,并分别根据入院NIHSS评分、头颅MRI梗死面积及发病90d mRS评分分级分成不同亚组,选取同期健康体检者90例为对照组,采用ELISA法分别测定血浆25-(OH)D及尿酸浓度。比较不同亚组间血浆25-(OH)D和尿酸浓度,评价两指标联合对缺血性脑卒中患者严重程度及早期预后的临床价值。结果病例组血浆25-(OH)D水平(19.39±6.02)ng/mL明显低于健康对照(25.88±8.73)ng/mL,尿酸水平(357.76±58.40)μmol/L高于对照组(295.19±59.87)μmol/L,差异有统计学意义(P<0.05)。随着缺血性脑卒中患者NIHSS评分增加、梗死面积增大及90d mRS评分增加,血浆25-(OH)D水平降低而尿酸水平增加(P<0.05);相关分析显示,血浆25-(OH)D与尿酸呈负相关(r=-0.491,P<0.05);ROC曲线分析显示,25-(OH)D曲线下面积(AUC)为0.736,最佳工作点(OOP)为17.23ng/mL,其诊断缺血性脑卒中不良预后的灵敏度75.2%,特异度63.2%;尿酸的AUC为0.734,最佳工作点(OOP)为363.50μmol/L,此时诊断不良预后的灵敏度70.2%,特异度71.6%。两指标联合的串联试验曲线下面积为0.770,灵敏度52.8%,特异度89.5%。结论 25-(OH)D和尿酸均为缺血性脑卒中严重程度及早期预后的预测因子,两者联合对缺血性脑卒中患者早期预后的评估优于单一指标,是判断患者病情及预后的客观指标。
Objective To investigate the value of serum 25-hydroxyvitamin D(25-(OH)D)and uric acid in assessing the severity and short-term outcomes of acute ischemic stroke.Methods A total of 166 patients with acute ischemic stroke who were hospitalized from July 2015 to June 2016 were selected as study group.According to the National Institutes of Health stroke score(NIHSS)and cerebral infarction area examined by MRI at the time of admission and the modified Rankin Scale(mRS)on the ninth day after the onset of stoke,all patients were divided into different subgroups.At the same moment,we recruited 90 healthy persons who took physical examination as control group.Then the serum 25-(OH)D and uric acid level were measured by enzymelinked immunosorbent assay and were evaluated to find out the relationships with the severity and short-term outcomes of stroke.Results The serum 25-(OH)D value in study group was(19.39±6.02)ng/mL,lower than(25.88±8.73)ng/mL in control group,but the uric acid level in study group(357.76±58.40)μmol/L was higher than control group(295.19±59.87)μmol/L(all P<0.05).With the increase of the NIHSS scores,cerebral infarction area,mRS scores and uric acid level were elevated,but the25-(OH)D level was decreased(all P<0.05).Correlation analysis showed that the 25-(OH)D level had a negative correlation with uric acid level(r=-0.491,P<0.05).And ROC curves analysis showed that the area under curve(AUC)of 25-(OH)D was0.736 and optimal operating point(OOP)was 17.23ng/mL,which had a sensitivity of 75.2% and a specificity of 63.2%in the diagnosis of bad prognosis of ischemic stroke.Similarly,ACU of uric acid was 0.734 and OOP was 363.50μmol/L,which disclosed that the sensitivity was 70.2% and the specificity was 71.6%.Conclusion Both 25-(OH)D and uric acid may be the risk factors for the severity and short-term outcomes of acute ischemic stroke.The combined evaluation of the two indicators is superior to the single one and is considered as an objective index to judge severity and prognosis of the disease.
出处
《中国实用神经疾病杂志》
2017年第5期3-7,共5页
Chinese Journal of Practical Nervous Diseases
