急性脑梗死rt-PA溶栓时NO/ET-1、L-Arg、PCT与神经功能关系及预测血管再通效能  

Relationship between NO/ET-1,L-Arg,PCT and neurological function during rt-PA thrombolysis in acute cerebral infarction and the prediction of vascular recanalization efficacy

作　　者：张奕颖 毛峥嵘[1] 罗莎[2] 江华[3] ZHANG Yiying;MAO Zhengrong;LUO Sha;JIANG Hua(Emergency Department of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan,China,450000;The Second Department of Encephalopathy,the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan,China,450000;Department of Immunology,Henan University of Traditional Chinese Medicine,Zhengzhou,Henan,China,450000)

机构地区：[1]河南中医药大学第一附属医院急诊科,河南郑州450000 [2]河南中医药大学第一附属医院脑病二科,河南郑州450000 [3]河南中医药大学免疫学系,河南郑州450000

出　　处：《分子诊断与治疗杂志》2022年第10期1761-1764,1769,共5页Journal of Molecular Diagnostics and Therapy

基　　金：河南省中医药科学研究专项课题(2018ZY1002)。

摘　　要：目的 探讨急性脑梗死重组人组织型纤溶酶原激活物(rt-PA)溶栓时一氧化氮与内皮素-1比值(NO/ET-1)、L-精氨酸(L-Arg)、血小板压积(PCT)与神经功能关系及预测血管再通效能。方法 选取2018年3月至2021年1月河南中医药大学第一附属医院收治的182例具有静脉溶栓指征急性脑梗死患者,根据rt-PA溶栓后血管再通情况分为非再通组(n=31)、再通组(n=151),比较两组基线资料、NO/ET-1、L-Arg、PCT水平,对所获得数据进行统计分析。结果 非再通组糖尿病心房颤动、NIHSS评分、NO/ET-1、L-Arg、PCT与再通组比较,差异有统计学意义(P<0.05);NO/ET-1(r=-0.875,P<0.001)、L-Arg(r=-0.901,P<0.001)与NIHSS评分呈负相关,PCT(r=0.804,P<0.001)与NIHSS评分呈正相关;将糖尿病、心房颤动、NIHSS评分控制后,NO/ET-1、L-Arg、PCT仍是血管再通的相关影响因素(P<0.05);NO/ET-1、L-Arg联合PCT预测血管再通的受试者工作特征曲线下面积(AUC)(0.896)大于单一的NO/ET-1(0.816)、L-Arg(0.778)、PCT(0.812);NO/ET-1、L-Arg高水平者血管再通率高于低水平者,PCT高水平者血管再通率低于低水平者(χ^(2)=32.475、28.344、35.495,P<0.05)。结论 急性脑梗死rt-PA溶栓前NO/ET-1、L-Arg降低及PCT升高与神经功能恶化和血管非再通风险增加有关,联合检测三者能为临床预测血管再通提供参考,从而为临床决策、治疗提供依据。Objective To investigate the ratio of nitric oxide to endothelin-1(NO/ET-1),L-arginine(L-Arg)during thrombolysis of recombinant human tissue plasminogen activator(rt-PA)in acute cerebral infarction,platelet packed product(PCT)and the relationship between nerve function and prediction of vascular recanalization efficacy. Methods A total of 182 patients with acute cerebral infarction with indications of intravenous thrombolysis were selected from March 2018 to January 2021. According to the recanalization of blood vessels after rt-PA thrombolysis,they were divided into the non-recanalization group(n=31)and the recanalization group(n=151). The baseline data,NO/ET-1,L-Arg,and PCT levels of the two groups were compared,and the obtained data were statistically analyzed. Pearson was used to analyze the relationship between each indicator and the NIHSS score,and the multi-factor Logistic regression equation was used to analyze the vascular recanalization. For related influencing factors,the receiver operating characteristic curve(ROC)and the area under the ROC(AUC)were used to analyze the indicators to predict the vascular recanalization efficiency,and to compare the vascular recanalization rate of the indicators with different expression levels. Results There were statistically significant differences in diabetic AF,NIHSS score,NO/ET-1,L-Arg,and PCT in the non-recan group compared with the recan group(P<0.05);NO/ET-1(r=-0.875,P<0.001),L-Arg(r=-0.901,P<0.001)were negatively correlated with NIHSS score and PCT(r=0.804,P<0.001)were positively correlated with NIHSS score. After controlling for diabetes,AF,and NIHSS score,NO/ET-1,L-Arg,and PCT were still relevant influences for revascularization(P<0.05). The area under the receiver operating characteristic curve(AUC)(0.896)of NO/ET-1,L-Arg combined with PCT in predicting vascular recanalization is greater than that of single NO/ET-1(0.816),L-Arg(0.778),PCT(0.812). Patients with high levels of NO/ET-1 and L-Arg had higher vascular recanalization rates than those with low leve

关 键 词：急性脑梗死 RT-PA NO/ET-1 L-ARG PCT 

分 类 号：R743.33[医药卫生—神经病学与精神病学]