高敏肌钙蛋白T动态变化在晚时间窗内进行血管内治疗的急性缺血性脑卒中患者中的预测价值  

Prognostic value of dynamic changes of high-sensitivity cardiac troponin T in acute ischemic stroke patients treated with endovascular thrombectomy in late time windows

作　　者：徐志嘉 贾振宇[1] 赵林波[1] 刘圣[1] 施海彬[1] 曹月洲[1] Zhijia Xu;Zhenyu Jia;Linbo Zhao;Sheng Liu;Haibin Shi;Yuezhou Cao(Department of Interventional Radiology,First Affiliated Hospital of Nanjing Medical University,Jiangsu Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院介入放射科,江苏南京210029

出　　处：《中华介入放射学电子杂志》2023年第1期42-47,共6页Chinese Journal of Interventional Radiology：electronic edition

摘　　要：目的探讨高敏肌钙蛋白T(high-sensitivity cardiac troponin T,hs-cTnT)动态变化与晚时间窗内接受机械取栓治疗的前循环大血管闭塞型急性缺血性脑卒中患者不良预后的相关性。方法共纳入161例患者,分别于入院时和24 h测量血清hs-cTnT。hs-cTnT升高定义为大于14 ng/L;hs-cTnT动态变化定义为两次测量值上升或下降超过20%且至少有一次大于14 ng/L。评价hs-cTnT动态变化与3个月时不良预后的相关性;比较入院时hs-cTnT升高与hs-cTnT动态变化预测3个月时不良预后的接收者操作特征(receiver-operating characteristic,ROC)曲线下面积(areas under the ROC curve,AUC)。结果67(41.6%)例患者发生hs-cTnT动态变化。多因素分析显示,hs-cTnT升高(P=0.014,P=0.038)和hs-cTnT动态变化(P<0.001,P<0.001)分别是不良预后和死亡的独立预测因素。AUC比较显示hs-cTnT动态变化对不良预后(AUC 0.765 vs 0.689,P=0.043)和死亡(AUC 0.818 vs 0.687,P=0.008)的预测价值要显著优于入院时hs-cTnT升高。结论hs-cTnT动态变化是晚时间窗进行血管内治疗的急性颅内大血管闭塞性脑卒中患者3个月时不良预后和死亡的独立预测因素。hs-cTnT动态变化对不良预后的预测价值要显著优于入院时hs-cTnT升高。Objective High-sensitivity cardiac troponin T(hs-cTnT)elevation is associated with a poor prognosis in acute ischemic stroke(AIS).Our study is to investigate the relationship between dynamic changes of hs-cTnT and poor prognosis in AIS patients with large vessel occlusion(LVO)in anterior circulation 3 months after endovascular thrombectomy in late time windows.Methods A total of 161 patients were enrolled.Hs-cTnT was measured at hospital admission and on the following day.Significant hs-cTnT elevation was defined as>14 ng/L.Dynamic changes were designated as a rise or fall of more than 20%with at least one hs-cTnT value above 14 ng/L.The association between dynamic changes of hs-cTnT and poor prognosis was evaluated.Areas under the receiver-operating characteristic(ROC)curve(AUC)for dynamic changes of hs-cTnT and hs-cTnT elevation on admission in predicting poor prognosis were compared.Results Sixty-seven(41.6%)patients had dynamic changes.Multivariable logistic regression analysis showed that hs-cTnT elevation on admission(P=0.014,P=0.038)and dynamic changes in hs-cTnT(P<0.001,P<0.001)were independent predictors of unfavourable outcome and death,respectively.Comparison of AUC demonstrated a significantly better performance of dynamic changes of hs-cTnT than hs-cTnT elevation on admission in predicting unfavourable outcome(AUC 0.765 vs 0.689,P=0.043)and death(AUC 0.818 vs 0.687,P=0.008).Conclusions In the present study,dynamic changes of hs-cTnT are independent predictors of 3-month poor prognosis and death.Furthermore,dynamic changes of hs-cTnT more powerfully predict 3-month poor prognosis than hs-cTnT elevation on admission.

关 键 词：动态变化 高敏肌钙蛋白T 急性缺血性脑卒中 血管内治疗 晚时间窗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]