血小板活化因子水平对急性脑梗死静脉溶栓后血管再闭塞的预测效能  

Predictive efficiency of plasma platelet activating factor levels on vascular reocclusion after intravenous thrombolysis for acute ce-rebral infarction

作　　者：何思思 黄向东 陈建媚 茅新蕾 HE Sisi;HUANG Xiangdong;CHEN Jianmei;MAO Xinlei(Department of Neurology,Wenzhou Central Hospital,Wenzhou 325000,China;不详)

机构地区：[1]温州市中心医院神经内科,325000 [2]温州市中心医院泛血管疾病管理中心实验室,325000

出　　处：《浙江医学》2024年第6期616-619,624,共5页Zhejiang Medical Journal

基　　金：温州市基础性科研项目(Y2020066)。

摘　　要：目的探讨血小板活化因子(PAF)水平对急性脑梗死患者静脉溶栓后发生血管再闭塞的预测效能。方法选择2019年1月至2022年6月在温州市中心医院神经内科住院并实施重组组织型纤溶酶原激活剂(rt-PA)治疗的急性脑梗死患者276例,将溶栓后血管再闭塞的患者61例作为观察组,未发生闭塞者215例作为对照组。收集并比较两组患者一般资料、美国国立卫生研究院卒中量表(NIHSS)评分、脑梗死部位及入院时PAF水平等资料,检测分析影响溶栓后血管再闭塞的独立预测因素,构建预测模型,使用ROC曲线比较血浆PAF水平及预测模型对溶栓后血管再闭塞的预测效能。结果观察组患者BMI、NIHSS评分、后循环脑梗死比例、血糖和血浆PAF水平高于对照组,差异均有统计学意义(均P<0.05)。logistic回归分析显示,NIHSS评分(OR=1.373,95%CI:1.137~1.658)、后循环脑梗死(OR=1.008,95%CI:1.001~1.015)和血浆PAF水平(OR=1.006,95%CI:1.002~1.010)均是静脉溶栓后血管再闭塞的影响因素(均P<0.05)。血浆PAF水平预测静脉溶栓后血管再闭塞的AUC为0.725(95%CI:0.632~0.778,P<0.001),最佳阈值是221.50 ng/L,灵敏度为0.739,特异度为0.688。预测模型预测急性脑梗死患者静脉使用rtPA溶栓后血管再闭塞的AUC为0.816(95%CI:0.748~0.874,P<0.001)。结论较高的血浆PAF水平可能是急性脑梗死患者静脉溶栓后血管再闭塞的独立预测因素,对溶栓后血管再闭塞具有较高的预测效能。Objective To analyze the predictive efficiency of plasma platelet activating factor(PAF)levels on vascular reocclusion after intravenous thrombolysis for patients with acute cerebral infarction.Methods A total of 276 patients with acute cerebral infarction,who were hospitalized at Department of Neurology,Wenzhou Central Hospital between January 2019 and June 2022 and underwent intravenous thrombolysis using recombinant tissue plasminogen activator,were selected.Among which,61 patients with vascular reocclusion after intravenous thrombolysis were assigned into the observation group and another 215 patients without vascular reocclusion were assigned into the control group.All patients'general data,National Institutes of Health Stroke Scale(NIHSS)scores,infarction locations and so on were collected and compared.Plasma PAF levels at admission were measured.Multivariate analysis was used to analyze the independent predictors of vascular reocclusion after intravenous thrombolysis;a prediction model was constructed,a nomogram was plotted,and the ROC curve was built to compare the predictive efficiencies on vascular reocclusion after intravenous thrombolysis between plasma PAF levels and the prediction model.Results Patients in the observation group had significantly higher BMI,NIHSS scores,percentage of post-circulation cerebral infarction,blood glucose levels and plasma PAF levels than those in the control group,and the differences were statistically significant(all P<0.05).The logistic regression analysis showed that NIHSS scores(OR=1.373,95%CI:1.137-1.658),post-circulation cerebral infarction(OR=1.008,95%CI:1.001-1.015)and plasma PAF levels(OR=1.006,95%CI:1.002-1.010)all were influential factors of vascular reocclusion after intravenous thrombolysis(all P<0.05).AUC of plasma PAF levels for predicting vascular reocclusion after intravenous thrombolysis was 0.725(95%CI:0.632-0.778;P<0.001),with an optimal cutoff value of 221.50 ng/mL,sensitivity of 0.739 and specificity of 0.688.AUC of the prediction model for predicti

关 键 词：急性脑梗死 静脉溶栓 血管再闭塞 血小板活化因子 

分 类 号：R743.33[医药卫生—神经病学与精神病学]