急性部分前循环供血区脑梗死患者血清S100β蛋白、8-OHDG,Lp-PLA2水平与rt-PA静脉溶栓再通及卒中后认知功能障碍的关系  

Relationship between serum S100β protein, 8-OHDG, LP-PLA2 levels and rt-PA intravenous thrombolytic recanalization and cognitive impairment after stroke in patients with acute partial anterior circulation cerebral infarction

作　　者：张弛 李浩 张淑霞 于海滨 王亚姣 冯社军[3] Zhang Chi;Li Hao;Zhang Shuxia(Department of Neurology,Tangshan Hongci Hospital Limited Company,Tangshan063000;不详)

机构地区：[1]唐山弘慈医院有限公司神经内科,063000 [2]唐山弘慈医院有限公司重症医学科,063000 [3]邯郸市中心医院神经内科

出　　处：《卒中与神经疾病》2023年第1期19-25,共7页Stroke and Nervous Diseases

基　　金：2021年河北省医学科学研究课题计划(20211627)。

摘　　要：目的 观察急性部分前循环供血区脑梗死(Partial anterior circulation infarction, PACI)患者血清S100β蛋白、8-羟基脱氧鸟苷酸(8-Hydroxydeoxyguanylate, 8-OHDG)、脂蛋白相关磷脂酶A2(Lipoprotein associated phospholipase A2,Lp-PLA2)水平变化,分析各指标水平与重组组织型纤溶酶原激活剂(Recombinant tissue plasminogen activator, rt-PA)静脉溶栓效果及12个月内发生卒中后认知功能障碍(Post-stroke cognitive impairment, PSCI)的关系。方法 选取2019年3月-2021年3月在本院静脉溶栓治疗的急性PACI患者127例为研究对象,记录溶栓再通及治疗后12个月内PSCI发生情况,分析血清S100β蛋白、8-OHDG,Lp-PLA2水平与溶栓再通及PSCI发生的关系,并进一步采用Logistic逐步回归分析溶栓再通及PSCI发生的影响因素,并绘制受试者工作特征(Receiver operating characteristic curve, ROC)曲线评价早期预测效能。结果 急性PACI患者rt-PA静脉溶栓后24 h内血管再通者96例(75.59%),血管未再通者31例(24.41%);发病至溶栓时间、溶栓前美国国立卫生研究院卒中量表(National institutes of health stroke scale, NIHSS)评分及血清S100β蛋白、8-OHDG,Lp-PLA2水平是PACI静脉溶栓血管未再通的独立危险因素(P<0.05)。静脉溶栓治疗后12个月内发生PSCI者50例(39.37%),未发生PSCI者77例(60.63%);FAZEKAS评分、溶栓未再通、溶栓后第7 d NIHSS评分及血清S100β蛋白、8-OHDG,Lp-PLA2水平是PACI静脉溶栓治疗后12个月内PSCI发生的独立危险因素(P<0.05)。NIHSS评分、发病至溶栓时间及FAZEKAS评分等基本临床参数结合血清S100β蛋白、8-OHDG,Lp-PLA2水平预测PACI静脉溶栓再通及溶栓治疗后12个月内PSCI发生的曲线下面积(Area under the curve, AUC)分别为0.889和0.903,明显高于单独预测,具有较高的临床预测价值。结论 急性PACI患者rt-PA静脉溶栓效果及PSCI发生与早期神经炎症及氧化应激反应密切相关,动态监测血清S100β蛋白、Lp-PLA2,8-OHDG水平�Objective To observe the changes of serum S100β protein, 8-hydroxydeoxyguanodic acid(8-OHDG), lipoprotein associated phospholipase A2(LP-PLA2) levels in patients with acute partial anterior circulation cerebral infarction(PACI), and to analyze the relationship between the levels of each indicator and the efficacy of intravenous throbolysis of RT-PA and cognitive impairment after stroke(PSCI) within 12 months. Methods A total of 127 patients with acute PACI who received intravenous thrombolytic therapy from March 2019 to March 2021 were adimtted to the study subjects, and to record the occurrence of PSCI within 12 months after thrombolytic recanalization and treatment. To analyze the relationship between serum levels of S100β protein, 8-OHDG and LP-PLA2 and the occurrence of thrombolytic recanalization and PSCI, and the influencing factors of thrombolytic recanalization and PSCI were further analyzed by Logistic stepwise regression, and the receiver operating characteristic(ROC) curve was plotted to evaluate the early prediction efficiency. Results In acute PACI patients, 96 patients(75.59%) were recanalized 24 h after RT-PA intravenous thrombolysis, and 31 patients(24.41%) were not recanalized. The time from onset to thrombolysis, NIHSS score before thrombolysis and serum S100β protein, 8-OHDG and LP-PLA2 levels were independent risk factors for non-recanalization of venous thrombolysis in PACI(P<0.05). PSCI occurred in 50 patients(39.37%) and did not occur in 77 patients(60.63%) within 12 months after intravenous thrombolytic therapy. FAZEKAS score, no recanalization after thrombolytic therapy, NIHSS score and serum S100β protein, 8-OHDG and LP-PLA2 levels at 7 days after thrombolytic therapy were independent risk factors for PSCI within 12 months after intravenous thrombolytic therapy for PACI(P<0.05). NIHSS score, time from onset to thrombolytic therapy, FAZEKAS score and other basic clinical parameters combined with serum S100β protein, 8-OHDG, LP-PLA2 predicted the occurrence of PSCI within 12 months af

关 键 词：S100β蛋白 8-羟基脱氧鸟苷酸 脂蛋白相关磷脂酶A2 部分前循环供血区梗死 静脉溶栓 认知功能障碍 

分 类 号：R743.3[医药卫生—神经病学与精神病学]