血清EPA/AA比值联合sTWEAK在合并脑白质疏松的急性脑梗死患者溶栓后出血转化和预后评估中的临床研究  

Clinical study of serum EPA/AA ratio combined with sTWEAK in the evaluation of hemorrhagic transformation and prognosis after thrombolysis in patients with acute cerebral infarction with leukoaraiosis

作　　者：叶佳伦 陈洁琼 王小山[1] 张钰[3] 王仁颖[1] YE Jialun;CHEN Jieqiong;WANG Xiaoshan;ZHANG Yu;WANG Renying(Department of Emergency,Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai,200025,China;Shanghai Institute of Immunology,Shanghai Jiaotong University School of Medicine;Department of Internal Medicine-Neurology,Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine)

机构地区：[1]上海交通大学医学院附属瑞金医院急诊科,上海200025 [2]上海交通大学医学院上海市免疫学研究所 [3]上海交通大学医学院附属瑞金医院神经内科

出　　处：《临床急诊杂志》2024年第2期69-75,共7页Journal of Clinical Emergency

基　　金：上海市“科技创新行动计划”自然科学基金领域项目(No:21ZR1440000)。

摘　　要：目的:探究血清二十碳五烯酸(eicosapentaenoic acid,EPA)/花生四烯酸(arachidonic acid,AA)比值联合可溶性肿瘤坏死因子样弱凋亡诱导剂(soluble tumor necrosis factor-like weak apoptosis inducer,sTWEAK)在合并脑白质疏松(leukoaraiosis,LA)的急性脑梗死患者溶栓后出血转化和预后评估中的临床价值。方法:选择2021年2月—2023年2月收治的149例急性脑梗死合并LA患者,均接受静脉溶栓治疗,根据其溶栓后出血转化情况分为非出血转化组与出血转化组,检测并比较两组血清EPA/AA比值、sTWEAK水平。分析血清EPA/AA比值联合sTWEAK预测急性脑梗死合并LA患者溶栓后出血转化的效能。随访3个月,采用改良Rankin量表(mRS)评估急性脑梗死合并LA患者的预后情况,根据预后将其分为预后良好组与预后不良组,比较两组临床资料、实验室指标及血清EPA/AA比值、sTWEAK水平。多因素回归分析急性脑梗死合并LA患者预后不良的影响因素;ROC曲线分析血清EPA/AA比值联合sTWEAK预测患者预后不良的价值。结果:与非出血转化组比较,出血转化组血清EPA、EPA/AA比值显著降低,sTWEAK显著升高,均差异有统计学意义(P<0.05)。当EPA/AA比值<0.37、sTWEAK>279.6 pg/mL时,两者联合预测急性脑梗死合并LA患者溶栓后出血转化的曲线下面积(area under the curve,AUC)、灵敏度、特异度依次为0.861、82.12%、90.14%,显著优于单项指标检测,差异有统计学意义(P<0.05)。多因素分析结果显示,年龄增大、sTWEAK升高、合并高血压、出血转化、溶栓24 h后NIHSS评分升高是急性脑梗死合并LA患者预后不良的危险因素(P<0.05),而EPA、EPA/AA比值升高为其保护因素(P<0.05)。血清EPA/AA比值联合sTWEAK检测预测急性脑梗死合并LA患者预后不良的AUC、灵敏度、特异度依次为0.899、83.32%、98.11%,显著优于单项指标检测,差异有统计学意义(P<0.05)。结论:血清EPA/AA比值下降、sTWEAK水平升高与合并LA的急性�Objective:To explore the clinical value of serum eicosapentaenoic acid(EPA)/arachidonic acid(AA)ratio combined with soluble tumor necrosis factor-like weak apoptosis inducer(sTWEAK)in assessing post thrombolytic hemorrhage transformation and prognosis in patients with acute cerebral infarction complicated with cerebral leukoaraiosis(LA).Methods:One hundred and forty nine patients with acute cerebral infarction with LA who were admitted from February 2021 to February 2023 were selected,and all patients treated with intravenous thrombolysis,the patients were divided into non-hemorrhagic transformation group and hemorrhagic transformation group according to the hemorrhagic transformation after thrombolysis.Serum EPA/AA ratio and sTWEAK level were detected and compared between the two groups.The efficacy of serum EPA/AA ratio combined with sTWEAK in predicting hemorrhagic transformation after thrombolysis in patients with acute cerebral infarction complicated with LA were analyzed.After 3 months of follow-up,the prognosis of patients with acute cerebral infarction with LA were evaluated by mRS,patients were divided into good prognosis group and poor prognosis group according to the prognosis,the clinical data,laboratory indexes,serum EPA/AA ratio and sTWEAK level were compared between two groups.The influencing factors of poor prognosis in patients with acute cerebral infarction with LA were analyzed by multivariate regression.The value of serum EPA/AA ratio combined with sTWEAK in predicting poor prognosis of patients were analyzed by ROC curve.Results:Compared with the nonhemorrhagic transformation group,the hemorrhagic transformation group showed a significant decrease in serum EPA and EPA/AA ratio(P<0.05),and a significant increase in sTWEAK(P<0.05).When the EPA/AA ratio was less than 0.37 and sTWEAK was greater than 279.6 pg/mL,the combined prediction of the area under the curve(AUC),sensitivity,and specificity of thrombolytic transformation in patients with acute cerebral infarction complicated with LA were 0.8

关 键 词：二十碳五烯酸/花生四烯酸比值 可溶性肿瘤坏死因子样弱凋亡诱导剂 急性脑梗死 脑白质疏松症 静脉溶栓 出血转化 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]