溶栓前血清尿酸、Hcy、Lp(a)对急性缺血性脑卒中患者溶栓预后的预测价值  

Predictive value of serum uric acid,Hcy and Lp(a)before thrombolysis for the prognosis of acute ischemic stroke patients after thrombolytic therapy

作　　者：丁燕萍 郭庆敏 张玉来 DING Yanping;GUO Qingmin;ZHANG Yulai(Department of Neurology,the Eighth People's Hospital of Hefei,Hefei,Anhui,China,238000)

机构地区：[1]合肥市第八人民医院神经内科,安徽合肥238000

出　　处：《分子诊断与治疗杂志》2024年第5期945-948,957,共5页Journal of Molecular Diagnostics and Therapy

基　　金：安徽省卫生健康委科研项目(AHWJ2021a010)。

摘　　要：目的探究溶栓前血清尿酸、同型半胱氨酸(Hcy)、脂蛋白(a)[Lp(a)]对急性脑缺血性脑卒中(AIS)患者溶栓预后的预测价值。方法选取2019年1月至2023年1月合肥市第八人民医院救治的AIS患者125例进行研究,根据溶栓后3个月随访结果分组,82例预后良好,43例预后不良。比较两组患者溶栓前血清尿酸、Hcy、Lp(a)水平、年龄、病史等临床资料;Logistic回归模型分析AIS患者溶栓预后的影响因素;通过受试者工作特征(ROC)曲线分析AIS患者溶栓前血清尿酸、Hcy、Lp(a)水平对其溶栓预后的预测价值。结果与预后良好组患者相比,不良组年龄、BMI、发病至溶栓时间、入院时NIHSS评分、血清Hcy、Lp(a)水平均更高,血清尿酸水平更低,差异均有统计学意义(t=10.563、4.086、20.083、14.177、6.103、5.494、6.980,P<0.05),预后不良组梗死大面积、高血压、糖尿病及房颤患者占比均高于预后良好组,差异有统计学意义(χ^(2)=11.786、11.159、7.212、12.116,P<0.05);年龄、发病至溶栓时间、入院时NIHSS评分、溶栓前高水平血清Hcy、Lp(a)是影响AIS患者预后的独立危险因素,溶栓前高水平血清尿酸则是其预后的保护因素;ROC曲线结果显示溶栓前血清尿酸、Hcy、Lp(a)水平对AIS患者溶栓预后进行预测的曲线下面积(AUC)分别为:0.814、0.760、0.755,三者联合预测的AUC为0.920,联合检测的预测价值高于单一指标(P<0.05)。结论溶栓前血清尿酸、Hcy、Lp(a)对急性缺血性脑卒中患者溶栓预后有一定预测价值,三者联合检测预测效能更高。Objective To investigate the predictive value of serum uric acid,homocysteine(Hcy)and lipoprotein(a)[Lp(a)]before thrombolysis in patients with acute cerebral ischemic stroke(AIS).Methods 125 AIS patients treated at the Eighth People's Hospital of Hefei City from January 2019 to January 2023 were selected for the study.According to the results of a 3⁃month follow⁃up after thrombolysis,82 pa⁃tients had a good prognosis,and 43 patients had a poor prognosis.Serum uric acid,Hcy and Lp(a)levels be⁃fore thrombolysis and other clinical data between the two groups were compared.A logistic regression model was used to analyze the factors affecting the prognosis of patients with AIS.The predictive value of serum uric acid,Hcy and Lp(a)levels before thrombolysis in AIS patients was analyzed using a receiver operating char⁃acteristic(ROC)curve.Results Compared to the good prognosis group,the poor prognosis group had high⁃er age,BMI,time from onset to thrombolysis,NIHSS score at admission,serum Hcy and Lp(a)levels,and lower serum uric acid levels.These differences were significant(t=10.563,4.086,20.083,14.177,6.103,5.494,6.980,P<0.05).In the poor prognosis group,the proportion of patients with large infarct,hypertension,diabetes and atrial fibrillation was higher than in the other group.The difference was statistically signifi⁃cant(χ^(2)=11.786,11.159,7.212,12.116,P<0.05).Multivariate logistic regression analysis showed that age,onset time to thrombolysis,NIHSS score at admission,pre⁃thrombolysis serum Hcy and Lp(a)were indepen⁃dent risk factors for poor prognosis in AIS patients,and a high level of serum uric acid before thrombolysis was a protective factor for prognosis.ROC curve results showed that the area under the curve(AUC)of serum uric acid,Hcy and Lp(a)levels before thrombolysis to predict the prognosis of AIS patients was 0.814,0.760 and 0.755,respectively.The AUC of the combined prediction of the three levels was 0.920,indicating that the predictive value of the combined detection was higher than

关 键 词：急性缺血性脑卒中 尿酸、同型半胱氨酸 脂蛋白(a) 溶栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]