血清C型凝集素样受体-2联合胰岛素抵抗预测急性缺血性卒中患者静脉溶栓后转归  

Serum C-type lectin-like receptor-2 combined with insulin resistance predicts the outcome of patients with acute ischemic stroke after intravenous thrombolysis

作　　者：纪海霞 汪晗 朱向阳 顾晨晨 易晓仪 Ji Haixia;Wang Han;Zhu Xiangyang;Gu Chenchen;Yi Xiaoyi(Nantong University Medical College,Nantong 226001;Nantong Sixth People's Hospital,Nantong 226001,China;The Second Affiliated Hospital of Nantong University,Nantong 226006,China)

机构地区：[1]南通大学医学院,226001 [2]南通大学第二附属医院神经内科,226001 [3]南通市第六人民医院神经内科,226006

出　　处：《国际脑血管病杂志》2021年第9期659-665,共7页International Journal of Cerebrovascular Diseases

基　　金：江苏省卫生健康委员会科研项目(H2019057);南通科技项目(MS12018042)。

摘　　要：目的探讨血清C型凝集素样受体-2(C-type lectin-like receptor 2,CLEC-2)联合胰岛素抵抗对急性缺血性卒中(acute ischemic stroke,AIS)患者静脉溶栓后转归的预测价值。方法回顾性连续纳入2019年10月至2021年3月在南通大学第二附属医院神经内科接受阿替普酶静脉溶栓治疗的AIS患者。根据发病后90 d时改良Rankin量表评分分为转归良好组(0~2分)和转归不良组(>2分)。利用稳态模型评估-胰岛素抵抗(homeostasis model assessment of insulin resistance,HOMA-IR)评估胰岛素抵抗情况。应用Person相关性分析确定CLEC-2与HOMA-IR的相关性。应用多变量logistic回归分析确定血清CELC-2、HOMA-IR与静脉溶栓后转归的相关性。应用受试者工作特征(receiver operating characteristic,ROC)曲线确定血清CLEC-2联合HOMA-IR对静脉溶栓后转归不良的预测价值。结果共纳入100例患者,男性56例(56.0%),年龄(70.6±10.86)岁(范围49~83岁),基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(10.00±6.36)分。74例(74.0%)转归良好,26例(26.0%)转归不良。Person相关性分析显示,血清CLEC-2与HOMA-IR存在显著正相关联系(r=0.523;P<0.001)。多变量logistic回归分析显示,校正混杂因素(C反应蛋白、基线NIHSS评分、发病至静脉溶栓时间)后,血清CLEC-2最高四分位数组[与最低四分位数组相比:优势比(odds ratio,OR)4.836,95%置信区间(confidence interval,CI)1.105~21.169;P=0.036]和HOMA-IR最高四分位数组(与第1~3四分位数组相比:OR 15,95%CI 2.647~30.722;P=0.002)是AIS患者静脉溶栓后转归不良的独立危险因素。ROC曲线分析显示,血清CLEC-2联合HOMA-IR预测转归不良的曲线下面积为0.785(95%CI 0.688~0.883;P<0.001),最佳截断值为0.72,敏感性和特异性分别为76.0%和95.0%。结论CLEC-2联合胰岛素抵抗对AIS患者静脉溶栓后转归不良具有一定的预测价值。Objective To investigate the predictive value of serum C-type lectin-like receptor 2(CLEC-2)combined with insulin resistance in the outcome of patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods Patients with AIS received alteplase intravenous thrombolytic therapy in the Department of Neurology,the Second Affiliated Hospital of Nantong University from October 2019 to March 2021 were enrolled retrospectively.According to the modified Rankin Scale score at 90 d after onset,they were divided into good outcome group(0-2)and poor outcome group(>2).Homeostasis model assessment of insulin resistance(HOMA-IR)was used to evaluate insulin resistance.Person correlation analysis was used to determine the correlation between CLEC-2 and HOMA-IR.Multivariate logistic regression analysis was used to determine the correlation between serum CELC-2,HOMA-IR and the outcome after intravenous thrombolysis.Receiver operating characteristic(ROC)curve was used to determine the predictive value of serum CLEC-2 combined with HOMA-IR for poor outcome after intravenous thrombolysis.Results A total of 100 patients were enrolled(56 males,56.0%;aged 70.6±10.86 years,range 49-83 years).The baseline National Institutes of Health Stroke Scale(NIHSS)score was 10.00±6.36.Senenty-four patients(74.0%)had a good outcome and 26(26.0%)had a poor outcome.Person correlation analysis showed that there was a significant positive correlation between serum CLEC-2 and HOMA-IR(r=0.523;P<0.001).Multivariate logistic regression analysis showed that after adjusting for confounding factors(C-reactive protein,baseline NIHSS score,onset-to-needle time),the highest quartile of serum CLEC-2(compared with the lowest quartile:odds ratio[OR]4.836,95%confidence interval[CI]1.105-21.169;P=0.036)and the highest quartile of HOMA-IR(compared with the quartile 1-3:OR 15,95%CI 2.647-30.722;P=0.002)were the independent risk factors for the poor outcome in patients with AIS after intravenous thrombolysis.ROC curve analysis showed that the area under the

关 键 词：卒中 脑缺血 外源凝集素类 C型 胰岛素抵抗 膜糖蛋白类 血栓溶解疗法 治疗结果 危险因素 生物标志物 

分 类 号：R743.3[医药卫生—神经病学与精神病学]