摘要
目的探讨血清超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)及脂蛋白相关磷脂酶A_(2)(lipoprotein-associated phospholipase A_(2),Lp-PLA_(2))对急性缺血性卒中患者静脉溶栓后早期神经功能恶化(early neurological deterioration,END)和脑实质血肿(parenchymal hematoma,PH)-2型出血性转化(hemorrhagic transformation,HT)的预测价值。方法回顾性纳入2018年1月至2021年1月期间在南京医科大学附属南京医院神经内科接受静脉溶栓治疗的急性缺血性卒中患者。END定义为溶栓后24 h美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分较入院时升高≥4分。PH-2型HT定义为存在明显占位效应的脑实质血肿或梗死灶远隔部位出血。应用多变量logistic回归分析确定END和PH-2型HT的独立影响因素。应用受试者工作特征曲线评估hs-CRP和Lp-PLA_(2)水平对END及PH-2型HT的预测价值。结果共纳入804例接受静脉溶栓治疗的急性缺血性卒中患者,其中63例(7.8%)在静脉溶栓后24 h内出现END,41例(5.1%)发生HT,其中38例为PH-2型HT。单变量分析显示,END组血清hs-CRP及Lp-PLA_(2)水平均显著高于非END组(P均<0.05),PH-2型HT组血清hs-CRP及Lp-PLA_(2)水平均显著高于无PH-2型HT组(P均<0.05)。多变量logistic分析显示,hs-CRP[优势比(odds ratio,OR)1.017,95%置信区间(confidence interval,CI)1.001~1.034;P=0.043]及Lp-PLA_(2)(OR 1.002,95%CI 1.000~1.003;P=0.020)为静脉溶栓后END的独立危险因素;此外,hs-CRP(OR 1.019,95%CI 1.002~1.036;P=0.027)及Lp-PLA_(2)(OR 1.002,95%CI 1.000~1.003;P=0.018)也是静脉溶栓后发生PH-2型HT的独立危险因素。受试者工作特征曲线分析显示,hs-CRP和Lp-PLA_(2)预测END的曲线下面积分别为0.675(95%CI 0.609~0.741;P<0.001)和0.606(95%CI 0.528~0.683;P=0.005),预测PH-2型HT的曲线下面积分别为0.641(95%CI 0.545~0.737;P=0.003)和0.600(95%CI 0.500~0.699;P=0.051)。结论基线血清hs-CRP和Lp-PLA_(2)较高是急性缺血性卒中患者�
Objective To investigate the predictive values of serum hypersensitive C-reactive protein(hs-CRP)and lipoprotein-associated phospholipase A_(2)(Lp-PLA_(2))for early neurological deterioration(END)and parenchymal hematoma(PH)-type 2 hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke treated with intravenous thrombolysis in the Department of Neurology,Nanjing First Hospital,Nanjing Medical University from January 2018 to January 2021 were enrolled retrospectively.END was defined as an increase of≥4 in the National Institutes of Health Stroke Scale(NIHSS)score at 24 h after thrombolysis compared with the baseline.PH-2 type HT was defined as parenchymal hematoma with obvious space occupying effect or hemorrhage at the distant site of infarct.Multivariate logistic regression analysis was used to determine the independent influencing factors of END and PH-2 type HT.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of hs-CRP and Lp-PLA_(2) levels for END and PH-2 type HT.Results A total of 804 patients with acute ischemic stroke treated with intravenous thrombolysis were included,of which 63(7.8%)developed END within 24 h after intravenous thrombolysis;41(5.1%)developed HT,of which 38 were PH-2 type HT.Univariate analysis showed that the levels of serum hs-CRP and Lp-PLA_(2) in the END group were significantly higher than those in the non-END group(all P<0.05),and the levels of serum hs-CRP and Lp-PLA_(2) in the PH-2 HT group were significantly higher than those in the non-PH-2 HT group(P<0.05).Multivariate logistic analysis showed that hs-CRP(odds ratio[OR]1.017,95% confidence interval[CI]1.001-1.034;P=0.043)and Lp-PLA_(2)(OR 1.002,95%CI 1.000-1.003;P=0.020)were the independent risk factors for END after intravenous thrombolysis.In addition,hs-CRP(OR 1.019,95%CI 1.002-1.036;P=0.027)and Lp-PLA_(2)(OR 1.002,95%CI 1.000-1.003;P=0.018)were also the independent risk factors for PH-2 HT after
作者
高擎
陈霓红
蒋伏平
Gao Qing;Chen Nihong;Jiang Fuping(Department of Neurology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)
出处
《国际脑血管病杂志》
2021年第12期898-903,共6页
International Journal of Cerebrovascular Diseases
基金
国家自然科学基金青年项目(81801263)。
关键词
急性缺血性卒中
静脉溶栓
出血性转化
曲线下面积
占位效应
受试者工作特征曲线
高敏C反应蛋白
单变量分析
Stroke
Brain ischemia
Thrombolytic therapy
C-Reactive protein
1-Alkyl-2-acetylglycerophosphocholine esterase
Disease progression
Time factor
Cerebral hemorrhage
Risk factors
Predictive value of tests
