急性缺血性脑卒中患者血清CKLF1、claudin-5预测溶栓后出血转化的价值及与短期预后的关系  

The value of serum CKLF1 and claudin-5 in predicting post thrombolytic bleeding transformation in patients with acute ischemic stroke and their relationship with short-term prognosis

作　　者：刘源[1] 刘星[1] 禹红[1] 熊武忠[1] 王乐[2] Liu Yuan;Liu Xing;Yu Hong;Xiong Wuzhong;Wang Le(Department of Clinical Laboratory,Wuhan Traditional Chinese Medicine Hospital,Hubei Province,Wuhan 430010,China)

机构地区：[1]武汉市中医医院检验科,武汉430010 [2]武汉市中医医院神经内科,武汉430010

出　　处：《疑难病杂志》2023年第9期902-908,共7页Chinese Journal of Difficult and Complicated Cases

基　　金：湖北省卫生健康委2019年度第二批联合基金立项项目(WJ2019MB344)。

摘　　要：目的分析急性缺血性脑卒中(AIS)患者血清趋化素样因子1(CKLF1)、claudin-5预测静脉溶栓后出血转化(HT)的价值及与短期预后的关系。方法选取2019年7月—2021年1月武汉市中医医院神经内科收治接受静脉溶栓的AIS患者321例为AIS组,根据是否发生HT分为HT亚组63例和非HT亚组258例。患者出院后3个月根据改良Rankin量表(mRS)评分再分为预后不良亚组88例和预后良好亚组233例,另选取医院同期体检健康志愿者60例为健康对照组。采用酶联免疫吸附法检测血清CKLF1、claudin-5水平,比较各组血清CKLF1、claudin-5水平。采用多因素Logistic回归分析AIS患者静脉溶栓后HT的影响因素;Spearman相关性分析AIS患者血清CKLF1、claudin-5水平与mRS评分的相关性;受试者工作特征(ROC)曲线分析血清CKLF1、claudin-5水平对AIS患者静脉溶栓后HT的预测价值。结果与健康对照组比较,AIS组血清CKLF1、claudin-5水平升高(Z=11.953、11.069,P均<0.001)。AIS患者321例静脉溶栓后HT发生率为19.63%(63/321)。心源性栓塞、美国国立卫生研究院卒中量表(NIHSS)评分升高和血清CKLF1、claudin-5升高为AIS患者静脉溶栓后HT的独立危险因素[OR(95%CI)=1.104(1.047~1.165)、4.377(2.011~9.526)、1.195(1.106~1.292)、1.039(1.024~1.052)]。AIS患者321例静脉溶栓后3个月预后不良发生率为27.41%(88/321)。与预后良好亚组比较,预后不良亚组血清CKLF1、claudin-5水平升高(Z=7.145、7.279,P均<0.001)。AIS患者血清CKLF1、claudin-5水平与mRS评分呈正相关(rs=0.517、0.491,P均<0.001)。血清CKLF1、claudin-5水平单独及二者联合预测AIS患者静脉溶栓后HT的曲线下面积(AUC)分别为0.769、0.772、0.876,二者联合预测的AUC大于CKLF1、claudin-5单独预测(Z=2.542、3.786,P均<0.001)。结论血清CKLF1、claudin-5水平升高是AIS患者静脉溶栓后HT的独立危险因素,二者联合预测AIS患者静脉溶栓后HT的价值较高,且血清CKLF1、claudin-5水平升高与AIS�Objective To analyze the value of serum chemokine like factor 1(CKLF1)and claudin-5 in predicting hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute ischemic stroke(AIS)and their relationship with short-term prognosis.Methods Select 321 AIS patients who received intravenous thrombolysis from the Neurology Department of Wuhan Traditional Chinese Medicine Hospital from July 2019 to January 2021 as the AIS group.According to the occurrence of HT,they are divided into an HT subgroup of 63 cases and a non-HT subgroup of 258 cases.Three months after discharge,the patient was divided into a subgroup of 88 patients with poor prognosis and a subgroup of 233 patients with good prognosis based on the Modified Rankin Scale(mRS)score.Additionally,60 healthy volunteers who underwent physical examination at the same time were selected as the healthy control group.Use enzyme-linked immunosorbent assay to detect serum CKLF1 and claudin-5 levels,and compare the levels of CKLF1 and claudin-5 in each group.Using multivariate logistic regression analysis to analyze the influencing factors of HT in AIS patients after intravenous thrombolysis;Spearman correlation analysis of the correlation between serum CKLF1,claudin-5 levels and mRS scores in AIS patients;The predictive value of serum CKLF1 and claudin-5 levels in predicting HT after intravenous thrombolysis in AIS patients using the receiver operating characteristic(ROC)curve analysis.Results Compared with the healthy control group,the serum levels of CKLF1 and claudin-5 in the AIS group increased(Z=11.953,11.069,P<0.001).The incidence of HT after intravenous thrombolysis in 321 AIS patients was 19.63%(63/321).Cardiogenic embolism,elevated National Institutes of Health Stroke Scale(NIHSS)scores,and elevated serum CKLF1 and claudin-5 levels are independent risk factors for HT after intravenous thrombolysis in AIS patients[OR(95%CI)=1.104(1.047-1.165),4.377(2.011-9.526),1.195(1.106-1.292),1.039(1.024-1.052)].The incidence of poor prognosis after 3 mont

关 键 词：急性缺血性脑卒中 趋化素样因子1 CLAUDIN-5 静脉溶栓 出血转化 短期预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]