单核细胞与高密度脂蛋白胆固醇比值预测急性缺血性卒中患者静脉溶栓治疗后早期神经功能恶化和出血性转化  

Monocyte-to-high-density lipoprotein cholesterol ratio predicts early neurological deterioration and hemorrhagic transformation after intravenous thrombolytic therapy in patients with acute ischemic stroke

作　　者：杨若蕊 俞刘珍雄 张康睿 吴君仓 Yang Ruorui;Yu Liuzhenxiong;Zhang Kangrui;Wu Juncang(Department of Neurology,Hefei Hospital Affiliated to Anhui Medical University(Hefei Second People's Hospital),Hefei 230011,China;The Fifth Clinical School of Medicine,Anhui Medical University,Hefei 230022,China;Department of Neurology,Hefei Second People's Hospital Affiliated to Bengbu Medical College,Hefei 230011,China)

机构地区：[1]安徽医科大学附属合肥医院(合肥市第二人民医院)神经内科,合肥230011 [2]安徽医科大学第五临床医学院,合肥230032 [3]蚌埠医学院附属合肥市第二人民医院神经内科,合肥230011

出　　处：《国际脑血管病杂志》2023年第2期87-93,共7页International Journal of Cerebrovascular Diseases

基　　金：合肥市借转补项目(J2019Y01)。

摘　　要：目的探讨单核细胞/高密度脂蛋白胆固醇比值(monocyte-to-high-density lipoprotein cholesterol ratio,MHR)对急性缺血性卒中(acute ischemic stroke,AIS)患者静脉溶栓后早期神经功能恶化(early neurological deterioration,END)和出血性转化(hemorrhagic transformation,HT)的预测价值。方法回顾性纳入2020年5月至2022年1月在合肥市第二人民医院接受静脉溶栓治疗的AIS患者。静脉溶栓前完成血液采集并计算MHR。END定义为入院后7 d内任意一次美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线增加≥2分或运动项评分较基线增加≥1分。HT定义为静脉溶栓后24 h内复查CT/MRI新发现的颅内出血。采用多变量logistic回归分析确定END和HT的独立预测因素,并采用受试者工作特征曲线分析MHR对END和HT的预测价值。结果共纳入186例接受静脉溶栓治疗的AIS患者,其中50例(26.9%)发生END,31例(16.7%)发生HT,中位MHR为0.43。END组MHR显著高于非END组(0.49对0.40;P=0.008),HT组MHR显著高于非HT组(0.52对0.40;P=0.013)。根据MHR水平四分位数从低到高将所有患者分为MHR1、MHR2、MHR3和MHR4。多变量logislic回归分析显示,校正混杂因素后,以MHR1为参考,MHR3[优势比(odds ratio,OR)6.317,95%置信区间(confidence interval,CI)1.465~27.237;P=0.013]和MHR4(OR 8.064,95%CI 1.910~34.051;P=0.005)是END的显著独立预测因素;以MHR1为参考,MHR4(OR 5.147,95%CI 1.194~22.182;P=0.028)是HT的显著独立预测因素。受试者工作特征曲线分析显示,MHR预测END的曲线下面积为0.628(95%CI 0.554~0.698,P=0.008),最佳MHR截断值为0.41时,其预测END的敏感性和特异性分别为74.0%和53.7%;MHR预测HT的曲线下面积为0.642(95%CI 0.569~0.711,P=0.013),最佳截断值为0.44时,其预测HT的敏感性和特异性分别为77.4%和58.1%。结论 MHR较高是AIS患者静脉溶栓后发生END和HT的危险因素,但MHR对END和HT的预测价值有限。Objective To investigate the predictive value of monocyte-to-high-density lipoprotein cholesterol ratio(MHR)for early neurological deterioration(END)and hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute ischemic stroke(AIS).Methods Patients with AIS received IVT in Hefei Second People's Hospital from May 2020 to January 2022 were retrospectively enrolled.Blood collection was completed and MHR was calculated before intravenous thrombolysis.END was defined as an increase of≥2 from the baseline in the National Institutes of Health Stroke Scale(NIHSS)score or≥1 from the baseline in motor function score at any time within 7 d after admission.HT was defined as intracranial hemorrhage newly found by CT/MRI within 24 h after intravenous thrombolysis.Multivariate logistic regression analysis was used to determine the independent predictors of END and HT,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of MHR for END and HT.Results A total of 186 patients with AIS treated with IVT were included,of which 50(26.9%)had END and 31(16.7%)had HT.The median MHR was 0.43.The MHR in the END group was significantly higher than that in the non-END group(0.49 vs.0.40;P=0.008),and the MHR in the HT group was significantly higher than that in the non-HT group(0.52 vs.0.40;P=0.013).All patients were divided into 4 groups(MHR1,MHR2,MHR3 and MHR4)according to the MHR quartile from low to high.Multivariate logistic regression analysis showed that after adjusting for confounding factors,taking MHR1 as a reference,MHR3(odds ratio[OR]6.317,95%confidence interval[CI]1.465-27.237;P=0.013)and MHR4(OR 8.064,95%CI 1.910-34.051;P=0.005)were the significant independent predictors of END;Taking MHR1 as a reference,MHR4(OR 5.147,95%CI 1.194-22.182;P=0.028)was the significant independent predictor of HT.The ROC curve analysis showed that the area under the curve of MHR for predicting END was 0.628(95%CI 0.554-0.698;P=0.008).When the optimal MHR cutoff value was 0.41,its se

关 键 词：缺血性卒中 血栓溶解疗法 疾病恶化 颅内出 单核细胞 胆固醇 HDL 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]