摘要
目的分析血栓-炎症因子水平与老年急性脑梗死(ACI)患者静脉溶栓预后的关系。方法将2020年12月—2023年1月我院收治的197例老年ACI患者作为研究对象,根据静脉溶栓后患者预后情况,分为预后良好组(143例)和预后不良组(54例)。对比两组患者的临床资料。通过多因素分析确定患者静脉溶栓预后不良的独立风险预测因子。对血栓-炎症因子水平对老年ACI患者静脉溶栓预后不良的预测价值进行评价。采用限制性立方样条模型分析血栓-炎症因子水平与老年ACI患者静脉溶栓预后不良的剂量反应关系。构建列线图模型;并对模型效能进行验证。采用Bootstrap重采样进行外部验证。结果多因素结果显示,发病至接受溶栓时间、治疗前NIHSS评分、TOAST分型、MCP-1、t-PA、sCD40L、P-选择素水平均为影响患者静脉溶栓预后不良的独立影响因素(P<0.05)。血栓-炎症因子水平对患者静脉溶栓预后不良具有一定的预测价值,且联合检测价值高于单独检测(AUC=820)。剂量反应关系分析结果显示当tPA≤60μg/L时,预后不良的风险随t-PA水平升高而升高(HR=1.005,CI 1.003~1.007,P<0.001);但当t-PA>60μg/L时,预后不良的风险几乎不再随t-PA水平升高而升高(HR=1.003,CI 1.001~1.006,P=0.614)。列线图模型的C-index为0.814和0.823,ROC曲线下面积为0.861和0.843,表明该预测模型的区分度良好。校准曲线拟合度良好,表明其准确度较高。临床决策曲线阈值概率在0.03~0.95和0.03~0.97范围内,有较高的净获益值,表明其有效性较好,安全可靠,实用性强。结论血栓-炎症因子水平对老年ACI患者静脉溶栓预后效果具有一定影响作用,并具有一定的预测价值,且各因子联合检测预测价值更高。
Objective To analyze the relationship between the levels of thrombo-inflammatory factors and the prognosis of intravenous thrombolysis in elderly patients with acute cerebral infarction(ACI).Methods The 197 elderly patients with ACI admitted to our hospital from December 2020 to January 2023 were selected as study subjects.According to the prognosis of patients after intravenous thrombolysis,patients were divided into a good prognosis group(n=143)and a poor prognosis group(n=54).The clinical data of patients in the two groups were compared.Multivariate analysis was used to identify independent risk predictors of poor prognosis in patients undergoing intravenous thrombolysis.The predictive value of thrombo-inflammatory factor levels for poor prognosis of intravenous thrombolysis in elderly patients with ACI was evaluated.A restricted cubic spline model was used to analyze the dose-response relationship between the levels of thrombo-inflammatory factors and the poor prognosis of intravenous thrombolysis in elderly patients with ACI.A nomograph model was constructed,and the effectiveness of the model was verified.Bootstrap resampling was used for external verification.Results Multivariate analysis results showed that the time from onset to receiving thrombolysis,pre-treatment National Institutes of Health Stroke Scale score,Trial of ORG 10172 in Acute Stroke Treatment typing,monocyte chemoattractant protein-1,t-PA,sCD40L,and P-selectin levels were independent influencing factors for poor prognosis of patients undergoing intravenous thrombolysis(P<0.05).The levels of thromboinflammatory factors had a certain predictive value for poor prognosis of patients undergoing intravenous thrombolysis,and the value of combined detection was higher than that of individual detection(area under the curve=820).The dose-response relationship analysis results showed that when t-PA≤60μg/L,the risk of poor prognosis increased with increasing t-PA level(HR 1.005,95%CI 1.003-1.007,P<0.001);when t-PA>60μg/L,the risk of poor prognosis
作者
施罗炯
孙静
SHI Luojiong;SUN Jing(Department of Neurology,Nanyang First People's Hospital,Nanyang 473000,China)
出处
《中风与神经疾病杂志》
CAS
2023年第12期1101-1107,共7页
Journal of Apoplexy and Nervous Diseases
基金
河南省青年科学基金项目(20220078)。
关键词
血栓-炎症因子
老年急性脑梗死
静脉溶栓
预后
Thrombo-inflammatory factor
Acute cerebral infarction in the elderly
Intravenous thrombolysis
Prognosis
