血清NCAM sTNFR1水平与超时间窗后循环脑卒中患者接受替罗非班治疗后神经预后的关系分析  

Analysis of the relationship between serum NCAM and sTNFR1 levels and neurological prognosis after tirofiban treatment in patients with stroke after time window

作　　者：王桂丽 张建华 徐欣 姚海涛 WANG Guili;ZHANG Jianhua;XU Xin;YAO Haitao(Cangzhou People’s Hospital,Cangzhou 061000,China;Tangshan Central Hospital,Tangshan 063000,China)

机构地区：[1]沧州市人民医院,河北沧州061000 [2]唐山中心医院,河北唐山063000

出　　处：《中国实用神经疾病杂志》2023年第3期312-317,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河北省医学科学研究课题计划项目(编号:20221847)。

摘　　要：目的探讨血清神经细胞黏附分子(NCAM)、可溶性肿瘤坏死因子受体1(sTNF-R1)水平与超时间窗后循环脑卒中(APCIS)患者接受替罗非班治疗后神经预后的关系。方法选择2019-03—2022-01唐山中心医院收治的100例超时间窗APCIS患者(APCIS组)和63例健康体检志愿者(对照组),根据NIHSS评分将APCIS患者分为轻度损伤组(<6分,27例)、中度损伤组(6~13分,39例)、重度损伤组(≥14分,34例)。所有患者入组后均接受替罗非班经微导管动脉给药[0.4μg/(kg·min)]和静脉持续泵注[0.1μg/(kg·min)]治疗48 h,配合降脂以及双抗血小板治疗。检测血清NCAM、sTNF-R1水平,出院后定期随访90 d,统计随访期间不良神经预后发生情况。多因素Logistic回归分析APCIS患者接受替罗非班治疗后神经预后不良的危险因素,受试者工作特征曲线(ROC)分析NCAM、sTNF-R1预测APCIS患者接受替罗非班治疗后神经预后不良的价值。结果APCIS组血清NCAM、sTNF-R1水平高于对照组(P<0.05),重度损伤组血清NCAM、sTNF-R1水平高于中度损伤组和轻度损伤组(P<0.05),预后不良组血清NCAM、sTNF-R1水平高于预后良好组(P<0.05)。房颤、高NIHSS评分、高NCAM、高sTNF-R1是APCIS患者接受替罗非班治疗后神经预后不良的危险因素(P<0.05)。NCAM、sTNF-R1预测APCIS患者接受替罗非班治疗后神经预后不良的曲线下面积为0.698、0.770,联合预测曲线下面积为0.937,高于单独指标预测(P<0.05)。结论APCIS患者血清NCAM、sTNFR-1水平增高,且与APCIS神经缺损程度以及替罗非班治疗后神经预后不良有关。Objective To investigate the relationship between serum levels of nerve cell adhesion mole⁃cule(NCAM),soluble tumor necrosis factor receptor 1(sTNF-R1)and neurological prognosis after tirofiban treat⁃ment in patients with post-time window circulating stroke(APCIS).Methods Totally 100 patients with APCIS over time window(APCIS group)and 63 healthy volunteers(control group)admitted to neurology department of our hospital from March 2019 to January 2022 were selected.According to NIHSS score,APCIS patients were divided into mild injury group(<6,27 cases)and moderate injury group(6-13 points).39 cases),severe injury group(≥14 points,34 cases).After inclusion,all patients received tirofiban via microcatheter arterial administra⁃tion(0.4μg·(kg/min))and intravenous continuous pumping 0.1μg·(kg/min))for 48 h,combined with lipidlowering and dual antiplatelet therapy.The serum NCAM and sTNF-R1 levels were detected,and the patients were followed up regularly for 90 days after discharge.The incidence of adverse neurological outcomes during the follow-up period was analyzed.Multivariate Logistic regression was used to analyze the risk factors of poor neuro⁃logical prognosis in APCIS patients treated with tirofiban,and receiver operating characteristic curve(ROC)was used to analyze the value of NCAM and sTNF-R1 in predicting poor neurological prognosis in APCIS patients treated with tirofiban.Results The serum levels of NCAM and sTNF-R1 in APCIS group were higher than those in control group(P<0.05),the serum levels of NCAM and sTNF-R1 in severe injury group were higher than those in moderate injury group and mild injury group(P<0.05),and the serum levels of NCAM and sTNF-R1 in poor prognosis group were higher than those in good prognosis group(P<0.05).Atrial fibrillation,high NIHSS score,high NCAM,and high sTNF-R1 were risk factors for poor neurological prognosis in APCIS patients treated with ti⁃rofiban(P<0.05).The area under the curve of NCAM and sTNF-R1 predicted poor neurological prognosis in AP⁃CIS patie

关 键 词：后循环缺血性脑卒中 静脉溶栓 替罗非班 神经细胞黏附分子 肿瘤坏死因子受体1 

分 类 号：R743.3[医药卫生—神经病学与精神病学]