α1抗胰蛋白酶在缺血性脑卒中短期神经功能、生活能力及再复发评估综合预后中的应用价值  

The application value ofα1 antitrypsin in the evaluation of the comprehensive prognosis of short-term neurological function,living ability and recurrence of ischemic stroke

作　　者：朱驰 金宁 马俊[1] 孙丽丽 于思远 杨冀[1] ZHU Chi;JIN Ning;MA Jun;SUN Lili;YU Siyuan;YANG Ji(Department of Clinical Laboratory,Dongfang Hospital Affiliated to Tongji University,Shanghai 200123,China)

机构地区：[1]同济大学附属东方医院检验科,上海200123

出　　处：《国际检验医学杂志》2021年第23期2855-2860,共6页International Journal of Laboratory Medicine

基　　金：上海市公共卫生体系建设三年行动计划(2020-2022年)(GWV-10.1-XK04)。

摘　　要：目的探讨α1抗胰蛋白酶(A1AT)在评价缺血性脑卒中患者综合预后中的应用价值。方法回顾性分析该院2018年2-5月收治的168例缺血性脑卒中患者临床资料,并于入院时、治疗7 d后行美国国立卫生研究院卒中量表评分,于治疗7 d后行改良Rankin量表及Essen卒中风险评估量表评分。联合评分量表,分为综合预后良好组(97例)和综合预后不良组(71例)。比较综合预后不良组与综合预后良好组的基线临床资料、抗栓治疗方式及A1AT等实验室指标的差异,采用受试者工作特征曲线分析有明显差异的指标在患者短期综合预后中的诊断预测价值。结果(1)综合预后良好组与综合预后不良组患者基线临床资料:年龄、入院收缩压、住院时间及房颤方面比较,差异均有统计学意义(P<0.05);(2)综合预后良好组与综合预后不良组实验室指标:入院时同型半胱氨酸(Z=-2.270,P=0.023)、A1AT(Z=-4.370,P=0.001)、纤维蛋白原(Z=-2.540,P=0.010)、凝血酶时间(Z=2.470,P=0.010)、红细胞沉降率(Z=-2.410,P=0.020)差异均有统计学意义;(3)二分类Logistic回归分析显示,患者入院时A1AT水平是缺血性脑卒中患者综合预后良好的保护因素(OR=0.940,95%CI:0.896~0.985,P=0.010);(4)受试者工作特征曲线分析显示,A1AT为预测缺血性脑卒中患者综合预后不良的最佳指标,阈值为135.50 mg/dL,曲线下面积为0.741,灵敏度为77.1%,特异度为59.2%。结论缺血性脑卒中患者入院时A1AT在患者短期神经功能预后、生活能力预后、卒中再复发风险评估中有一定价值,应重视患者入院时实验室指标对患者综合预后的影响。Objective To explore the application value ofα1 antitrypsin(A1AT)in evaluating the comprehensive prognosis of patients with ischemic stroke.Methods The clinical data of 168 patients with ischemic stroke treated in the hospital from February to May 2018 were analyzed retrospectively.The national institutes of health stroke risk assessment scale was performed on admission and 7 d after treatment,and the modified Rankin scale and Essen stroke kisk scale assessment were performed on 7 d after treatment.Combined scoring scale,divided the patients into the comprehensive good prognosis group(97 cases)and the comprehensive poor prognosis group(71 cases).Compared the differences in baseline clinical data,antithrombotic treatment methods,A1AT and other laboratory indicators between comprehensive poor prognosis group and comprehensive good prognosis group.The receiver operating characteristic curve was used to analyze the diagnostic predictive value of significantly different indicators in the short-term comprehensive prognosis of patients.Results(1)The baseline clinical data of patients in the comprehensive good prognosis group and the comprehensive poor prognosis group:compared with age,admission systolic blood pressure,length of stay and atrial fibrillation,the differences were statistically significant(P<0.05).(2)Laboratory indicators between the comprehensive good prognosis group and the comprehensive poor prognosis group:compared with homocysteine at admission(Z=-2.270,P=0.023),A1AT(Z=-4.370,P=0.001),fibrinogen(Z=-2.540,P=0.010),thrombin time(Z=2.470,P=0.010),erythrocyte sedimentation rate(Z=-2.410,P=0.020),the differences were statistically significant.(3)Binary Logistic regression analysis showed that A1AT level at admission was a protective factor for a comprehensive good prognosis of ischemic stroke patients(OR=0.940,95%CI:0.896-0.985,P=0.010).(4)Receiver operating characteristic curve analysis showed that A1AT was the best indicator for predicting the comprehensive poor prognosis of patients with ischemic stroke

关 键 词：缺血性脑卒中 实验室指标 Α1抗胰蛋白酶 功能预后 脑卒中再复发 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R446.1[医药卫生—临床医学]