血浆和肽素水平对急性缺血性卒中患者转归的预测价值  

Predictive value of plasma copeptin level for the outcomes in patients with acute ischemic stroke

作　　者：衣香明[1] 王媛[1] 王玉良[1] 董晓梦[1] 胡耀芝 陈金波[1] 

机构地区：[1] 滨州医学院附属医院神经内科,256603 [2] 胜利油田中心医院神经内科,东营257034

出　　处：《国际脑血管病杂志》2015年第9期657-661,共5页International Journal of Cerebrovascular Diseases

基　　金：滨州市科技发展项目（2011zc0904）

摘　　要：目的：探讨血浆和肽素水平对急性缺血性卒中患者转归的预测价值。方法纳入连续的急性缺血性卒中患者,应用酶联免疫吸附法检测血浆和肽素水平,应用美国国立卫生研究院卒中量表（ National Institutes of Health Stroke Scale, NIHSS）评估基线卒中严重程度。90 d时采用改良Rankin 量表（modified Rankin Scale, mRS）评估转归,转归良好定义为 mRS 评分1～2分。结果共纳入160例急性缺血性卒中患者,其中121例转归良好,39例转归不良。转归不良组年龄[（71．87±6．11）岁对（66．19±9．39）岁； t =-3．540, P =0．001]、血清 C 反应蛋白水平[（6．84±2．80）mmol/L 对（5．84±2．89）mmol/L； t =-2．459, P =0．023]、血浆和肽素水平[（143．12±34．02）pmol/L 对（50．78±18．62）pmol/L；t =21．564,P〈0．001]、NIHSS 评分[（12．00±4．00）分对（6．00±3．00）分；t =-7．861,P〈0．001]以及高血压（79．5%对60．3%；χ2=4．758,P =0．029）、心房颤动（20．51%对7．44%；χ2=4．022,P =0．045）和大动脉粥样硬化性卒中（43．59%对22．31%；χ2=6．696,P =0．010）的患者比例均显著高于转归良好组,舒张压显著低于转归良好组[（89±12）mmHg 对（95±9）mmHg,1 mmHg =0．133 kPa；t =3．323,P =0．001]。多变量 logistic 回归分析显示,血浆和肽素水平（优势比2．482,95%可信区间1．880～3．522；P〈0．001）和 NIHSS 评分（优势比2．332,95%可信区间1．725～3．153；P〈0．001）是急性缺血性卒中患者转归不良的独立危险因素。Person 相关分析显示,急性缺血性卒中患者血浆和肽素水平与基线 NIHSS 评分呈显著正相关（r =0．895,P〈0．001）。受试者工作特征曲线分析显示,血浆和肽素水平对急性缺血性卒中患者发病后90 d时转归不良具有显著预测价值（曲线下面积=0．740,95%可信区间0．623～0．783；P〈0．01）。以血浆和肽素水平〉104．3 pmol/L作为截断值,预测Objective To investigate the predictive value of plasma copeptin level for the outcomes in patients with acute ischemic stroke. Methods Consecutive patients with acute ischemic stroke were enroled in the study. Enzyme-linked immunosorbent assay was used to detect the plasma copeptin level. The National Institutes of Health Stroke Scale （NIHSS） was used to evaluate baseline stroke severity. The outcome was evaluated at 90 days with the modified Rankin Scale （mRS）, and the good outcome was defined as mRS 0 - 2. Results A total of 160 patients with acute ischemic stroke were enroled, 121 had good outcome and 39 had poor outcome. The age （71. 87 ± 6. 11 years vs. 66. 19 ± 9. 39 years; t =- 3. 540, P = 0. 001）, serum levels of C-reactive protein （6. 84 ± 2. 80 mmol/L vs. 5. 84 ± 2. 89 mmol/L;t = - 2. 459, P = 0. 023） and copeptin （143. 12 ± 34. 02 pmol/L vs. 50. 78 ± 18. 62 pmol/L; t = 21. 564, P〈0. 001）, NIHSS score （12. 00 ± 4. 00 vs. 6. 00 ± 3. 00; t = - 7. 861, P〈 0. 001）, as wel as proportions of patients with hypertension （79. 5% vs. 60. 3% ; χ2 = 4. 758, P = 0. 029）, atrial fibrilation （20. 51% vs. 7. 44% ; χ2 = 4. 022, P = 0. 045）, and large artery atherosclerotic stroke （43. 59% vs. 22. 31% ; χ2 = 6. 696, P = 0. 010） in the poor outcome group were significantly higher than those in the good outcome group, but diastolic blood pressure was significantly lower （89 ± 12 mmHg vs. 95 ± 9 mmHg, 1 mmHg = 0. 133 kPa;t = 3. 323, P = 0. 001）. Multivariate logistic regression analysis showed that the plasma copeptin level （odds ratio 2. 332, 95% confidence interval 1. 725 - 3. 153; P〈 0. 001） was an independent risk factor for the poor outcome in patients with acute ischemic stroke. Person correlation analysis showed that the plasma copeptin level and baseline NIHSS score showed a significant positive correlation （r = 0. 895, P〈 0. 001）. Receiver operating characteristic （ROC） analysis showed that plasma copeptin level has a significant predictive v

关 键 词：卒中 脑缺血 糖肽类 生物学标记 转归 和肽素类 

分 类 号：R743.3[医药卫生—神经病学与精神病学]