血清AAT、RANTES、Resistin水平与大动脉粥样硬化型急性缺血性卒中患者病情及预后的关系研究  

Relationship between serum AAT,RANTES,and Resistin levels and the condition and prognosis of patients with acute ischemic stroke with atherosclerosis of large arteries

作　　者：张菲菲 赵佳庆 张海刚 燕斌 张东亚 Zhang Feifei;Zhao Jiaqing;Zhang Haigang;Yan Bin;Zhang Dongya(Department of Neurology,Xianyang Hospital,Yan'an University,Shaanxi Province,Xianyang 712000,China)

机构地区：[1]延安大学咸阳医院神经内科,咸阳712000

出　　处：《疑难病杂志》2024年第4期440-445,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：陕西省2021年科技计划青年项目(2021QJ-716)。

摘　　要：目的探讨血清α-1抗胰蛋白酶(AAT)、受激活调节正常T细胞表达和分泌因子(RANTES)、抵抗素(Resistin)水平与大动脉粥样硬化(LAA)型急性缺血性卒中(AIS)患者病情及预后的关系。方法选取2022年1月—2023年1月延安大学咸阳医院神经内科收治的LAA型AIS患者159例纳入AIS组,根据入院时美国国立卫生研究院卒中量表(NIHSS)评分分为轻度亚组31例,中度亚组72例,重度亚组56例,另选取同期医院体检健康志愿者84例纳入健康对照组。随访90 d后,根据改良Rankin量表评分将LAA型AIS患者分为预后不良亚组61例和预后良好亚组98例。多因素Logistic回归分析LAA型AIS患者预后影响因素,受试者工作特征(ROC)曲线分析血清AAT、RANTES、Resistin水平预测LAA型AIS患者预后的价值。结果与健康对照组比较,AIS组血清AAT、RANTES、Resistin水平升高(t/P=16.897/<0.001、20.334/<0.001、17.775/<0.001);血清AAT、RANTES、Resistin水平在轻度亚组、中度亚组、重度亚组中依次升高(F/P=146.195/<0.001、192.910/<0.001、194.396/<0.001)。随访90 d,LAA型AIS患者159例预后不良发生率为38.36%(61/159)。影响LAA型AIS患者预后的独立危险因素为年龄增加、合并糖尿病、入院时NIHSS评分增加、AAT升高、RANTES升高、Resistin升高[OR(95%CI)=1.078(1.019~1.141)、2.774(1.010~7.622)、1.106(1.054~1.160)、1.597(1.057~2.414)、1.136(1.059~1.219)、1.097(1.035~1.163)];血清AAT、RANTES、Resistin水平及三者联合预测LAA型AIS患者预后不良的ROC曲线下面积分别为0.769、0.771、0.766、0.897,三者联合的曲线下面积大于单独预测(Z/P=3.484/0.001、3.416/0.001、3.230/0.001)。结论LAA型AIS患者血清AAT、RANTES、Resistin水平升高与病情加重和预后不良密切相关,血清AAT、RANTES、Resistin水平联合预测LAA型AIS患者预后不良的价值较高。Objective To investigate the relationship between serum alpha-1 antitrypsin(AAT),regulated upon activation normal T cell expressed and secreted(RANTES),and Resistin levels and the condition and prognosis of patients with large artery atherosclerosis(LAA)-type acute ischemic stroke(AIS).Methods One hundred and fifty-nine patients with LAA-type AIS were admitted to the Department of Neurology,Xianyang Hospital,Yan'an University,from January 2022 to January 2023,and included them in the AIS group.31 patients were divided into mild subgroups,72 cases of moderate subgroups,and 56 cases of severe subgroups according to the score of the National Institutes of Health Stroke Scale(NIHSS)at the time of hospitalization.In addition,84 cases of healthy volunteers who underwent physical examination in the hospital during the same period were selected to be included in the healthy control group.After 90 d of follow-up,patients with LAA-type AIS were categorized into 61 cases of poor prognosis subgroup and 98 cases of good prognosis subgroup according to the modified Rankin Scale score.Multifactorial Logistic regression was used to analyze the factors affecting the prognosis of LAA-type AIS patients,and receiver operating characteristics(ROC)curves were analyzed to predict the prognostic value of serum AAT,RANTES,and Resistin levels in LAA-type AIS patients.Results Compared with the healthy control group,and the serum AAT,RANTES,and Resistin levels were elevated in the AIS group(t/P=16.897/<0.001,20.334/<0.001,and 17.775/<0.001).AAT,RANTES,and Resistin levels were elevated in mild,moderate,and severe subgroups in that order(F/P=146.195/<0.001,192.910/<0.001,194.396/<0.001).At 90 d of follow-up,the incidence of poor prognosis in 159 patients with LAA-type AIS was 38.36%.Independent risk factors affecting the prognosis of patients with LAA type AIS were increased age,diabetes mellitus,increased NIHSS score on admission,elevated AAT,elevated RANTES,and elevated Resistin[OR(95%CI)=1.078(1.019-1.141),2.774(1.010-7.622),1.106(1.054-1.

关 键 词：急性缺血性卒中 大动脉粥样硬化型 α-1抗胰蛋白酶 受激活调节正常T细胞表达和分泌因子 抵抗素 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]