血清总胆红素和iNOS联合检测对rt-PA静脉溶栓急性缺血性脑卒中患者预后的预测价值  

The prognostic value of combined detection of serum total bilirubin and iNOS in acute ischemic stroke patients with rt-PA intravenous thrombolysis

作　　者：李景莉 孙丽燕 来治国 李亚楠[1] 韩笑 肖静 LI Jing-li;SUN Li-yan;LAI Zhi-guo;LI Ya-nan;HAN Xiao;XIAO Jing(Department of Neurology,PLA 81st Group Military Hospital,Zhangjiakou,Hebei 075000;Department of General,Shizuizi Township Hospital,Chongli District,Zhangjiakou,Hebei 076350;Department of Ultrasound Imaging,Beijing First Integrated Chinese and Western Medicine Hospital,Beijing 10000;Information Engineering Division,PLA 81st Group Military Hospital,Zhangjiakou,Hebei 075000,China)

机构地区：[1]中国人民解放军陆军第八十一集团军医院神经内科,河北张家口075000 [2]张家口市崇礼区石嘴子乡卫生院全科,河北张家口076350 [3]北京市第一中西医结合医院超声影像科,北京100000 [4]中国人民解放军陆军第八十一集团军医院信息工程科,河北张家口075000

出　　处：《热带医学杂志》2021年第10期1323-1326,1331,共5页Journal of Tropical Medicine

基　　金：张家口市重点研发计划项目(1921134H)。

摘　　要：目的分析血清总胆红素(TBIL)和诱生型一氧化氮合酶(iNOS)对重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓急性缺血性脑卒中患者预后的预测价值。方法收集中国人民解放军陆军第八十一集团军医院与北京市第一中西医结合医院2018年5月-2019年5月102例rt-PA静脉溶栓急性缺血性脑卒中患者为研究对象,根据患者经rt-PA静脉溶栓治疗3个月后改良Rankin量表(mRS)评分分为预后良好组(n=68)和预后不良组(n=34)。采用全自动生化分析仪检测血清中TBIL水平,酶联免疫吸附(ELISA)法检测血清中iNOS水平。结果与预后良好组相比,预后不良组血清中iNOS水平升高(P<0.05),血清中TBIL水平降低(P<0.05)。ROC曲线显示,血清中TBIL、i NOS水平联合预测rt-PA静脉溶栓急性缺血性脑卒中患者不良预后的ROC曲线下面积为0.885,敏感性为85.3%,特异性为82.4%。Logistic分析显示,年龄、入院时NIHSS评分、血清中iNOS高是影响rt-PA静脉溶栓急性缺血性脑卒中患者预后的危险因素,血清中TBIL高是rt-PA静脉溶栓急性缺血性脑卒中患者预后的保护因素。结论 rt-PA静脉溶栓急性缺血性脑卒中患者血清TBIL、iNOS水平与预后关系密切,在临床上值得关注。Objective To analyze the prognostic value of serum total bilirubin(TBIL)combined with inducible nitric oxide synthetase(iNOS)in acute ischemic stroke patients with intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA). Methods 102 acute ischemic stroke patients with rt-PA intravenous thrombolysis from May 2018 to May 2019 in the 81 st Hospital of Pepole ’ s Liberation Army and Beijing First Hospital of Integrated Traditional Chinese and Western Medicine were selected as the study objects;according to the modified Rankin scale(mRS)score of patients after3 months,the patients were divided into the good prognosis group(68 cases)and the poor prognosis group(34 cases).General data of the two groups were collected;the level of TBIL in serum was detected by automatic biochemical analyzer;the level of iNOS in serum was detected by enzyme-linked immunosorbent assay(ELISA). Results Compared with the good prognosis group the level of iNOS in serum in the poor prognosis group were higher(P<0.05),and the level of TBIL in serum were lower(P<0.05). The ROC curve showed that the serum TBIL and i NOS levels combined to predict the poor prognosis of rt-PA intravenous thrombolytic patients with acute ischemic stroke had an area under the ROC curve of 0.885,with a sensitivity of 85.3%,and a specificity of 82.4%. Logistic analysis showed that age,NIHSS score at admission and high iNOS in serum were risk factors for prognosis of acute ischemic stroke patients with rt-PA intravenous thrombolysis,and high TBIL in serum were protective factors for the prognosis of acute ischemic stroke patients with rt-PA intravenous thrombolysis. Conclusion The serum TBIL and iNOS levels of rt-PA intravenous thrombolysis patients with acute ischemic stroke were closely related to the prognosis,and they were worthy of clinical attention.

关 键 词：血清总胆红素 诱生型一氧化氮合酶 重组组织型纤溶酶原激活剂静脉溶栓 急性缺血性脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]