白细胞介素-2和对氧磷脂酶-1评估急性脑卒中患者阿替普酶静脉溶栓后短期预后的价值  

Values of serum interleukin-2 and paraoxophospholipase-1 to the prediction of short-term prognosis of patients with acute stroke after intravenous thrombolysis with alteplase

作　　者：杨静 裴斐菲 赛米热·沙塔尔 YANG Jing;PEI Fei-fei;Saimire SHATAER(Teaching and Scientific Research Management Office,the Second Affiliated Hospital of Xinjiang Medical University,Xinjiang Key Laboratory of Neurological Disorder Research,Xinjiang Uygur Autonomous Region 830054,China;Department of Neurology,the Second Affiliated Hospital of Xinjiang Medical University,Xinjiang Uygur Autonomous Region 830054,China)

机构地区：[1]新疆医科大学第二附属医院教学科研管理办公室、新疆神经系统疾病研究重点实验室,新疆维吾尔自治区乌鲁木齐830054 [2]新疆医科大学第二附属医院神经内科,新疆维吾尔自治区乌鲁木齐830054

出　　处：《中华实用诊断与治疗杂志》2023年第3期294-299,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：新疆神经系统疾病研究重点实验室开放课题(XJDX1711-2248)。

摘　　要：目的探讨阿替普酶静脉溶栓治疗前血清白细胞介素-2(interleukin-2,IL-2)、对氧磷脂酶(paraoxophospholipase,PON)-1水平预测急性缺血性脑卒中(acute ischemic stroke,AIS)患者短期预后的价值。方法250例AIS患者给予营养神经、抗血小板聚集、控制血压、血糖等常规治疗,并于发病4.5 h内应用阿替普酶静脉溶栓。记录患者入院时血小板计数、凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、三酰甘油、随机血糖、D-二聚体、IL-2、PON-1水平;记录入院时和治疗14 d时美国国立卫生研究院卒中量表评分(National Institutes of Health Stroke Scale,NIHSS),入院时和治疗3个月时改良Rankin量表(modified Rankin scale,mRS)评分。依据治疗3个月后mRS评分,将250例患者分为预后良好组55例和预后不良组195例,比较2组IL-2、PON-1等指标;多因素logistics回归分析AIS患者阿替普酶静脉溶栓治疗后预后不良的影响因素;采用限制性立方样条分析血清IL-2、PON-1水平与AIS患者阿替普酶溶栓后预后不良的相关性;绘制ROC曲线,评估治疗前血清IL-2、PON-1预测AIS患者阿替普酶静脉溶栓后预后不良的效能。结果(1)预后不良组年龄≥80岁比率(60.00%)、随机血糖[(10.23±3.74)mmol/L]及IL-2[(369.54±88.95)ng/L]水平均高于预后良好组[43.59%、(8.25±2.88)mmol/L、(296.48±79.27)ng/L)],PON-1水平[(86.45±11.29)ng/L]低于预后良好组[(97.34±12.66)ng/L](P<0.05),血小板计数、凝血酶原时间、活化部分与凝血活酶时间等指标与预后良好组比较差异均无统计学意义(P>0.05)。(2)预后良好组治疗14 d时NIHSS评分[(7.42±1.98)分]、治疗3个月时mRS评分[(1.43±0.29)分]均低于预后不良组[(9.11±2.35)分、(3.62±0.24)分]及入院时[(15.33±4.16)分、(3.55±0.81)分](P<0.05)。(3)年龄≥80岁(OR=2.171,95%CI:1.068~4.413,P=0.032)、NIHSS评分(OR=1.681,95%CI:1.320~2.140,P<0.001)�Objective To investigate the values of serum interleukin-2(IL-2)and paraoxophospholipase-1(PON-1)levels before intravenous thrombolysis with alteplase to the prediction of the short-term prognosis of patients with acute ischemic stroke(AIS).Methods Totally 250 AIS patients received intravenous thrombolysis with alteplase within 4.5 h after onset besides routine treatment such as nutrition,antiplatelet therapy,blood pressure control,and plasma glucose control.The clinical laboratory data were collected,as platelet count,prothrombin time,activated partial thromboplastin time,fibrinogen,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,triacylglycerol,random plasma glucose,D-dimer,IL-2and PON-1were recorded on admission.The National Institutes of Health Stroke Scale(NIHSS)scores on admission and after treatment for 14days and the modified Rankin scale(mRS)scores on admission and after treatment for 3months were recorded.According to the mRS after treatment for 3months,250patients were divided into good prognosis group(n=55)and poor prognosis group(n=195),and IL-2,PON-1and other indicators were compared between two groups.Multivariate logistic regression was done to analyze the influencing factors of poor prognosis of patients with AIS after intravenous thrombolysis.Restricted cubic spline analysis was used to assess the correlations of IL-2and PON-1with poor prognosis.The ROC curves were drawn to evaluate the efficiencies of IL-2and PON-1on predicting poor prognosis.Results(1)The percentage of patients aged≥80years,random plasma glucose and IL-2levels were higher in poor prognosis group[60.00%,(10.23±3.74)mmol/L,(369.54±88.95)ng/L]than those in good prognosis group[43.59%,(8.25±2.88)mmol/L,(296.48±79.27)ng/L],and the PON-1level was lower in poor prognosis group[(86.45±11.29)ng/L]than that in good prognosis group[(97.34±12.66)ng/L](P<0.05).There were no significant differences in platelet count,prothrombin time,and activated partial thromboplastin time between two grou

关 键 词：急性缺血性脑卒中 静脉溶栓 阿替普酶 对氧磷脂酶-1 白细胞介素-2 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]