大血管闭塞型急性缺血性脑卒中患者血清PTX3水平与机械取栓首次通过效应及预后的相关性研究  

Association of Serum PTX3 Level with First-pass Effect and Prognosis of Mechanical Thrombectomy in Patients with Acute Ischemic Stroke of Large Vessel Occlusion

作　　者：郝瑜[1] 刘超[2] 曹银光[1] 李长云[1] HAO Yu;LIU Chao;CAO Yinguang;LI Changyun(Department of Clinical Laboratory,Liaocheng People’s Hospital,Shandong Liaocheng 252000,China;Department of Neurosurgery,Liaocheng People’s Hospital,Shandong Liaocheng 252000,China)

机构地区：[1]聊城市人民医院检验科,山东聊城252000 [2]聊城市人民医院神经外科,山东聊城252000

出　　处：《现代检验医学杂志》2024年第4期110-115,共6页Journal of Modern Laboratory Medicine

基　　金：山东省科技厅自然科学基金面上项目(编号ZR2017MH099)。

摘　　要：目的探讨正五聚蛋白3(pentraxin 3,PTX3)与大血管闭塞型急性缺血性脑卒中(acute ischemic stroke,AIS)患者机械取栓首次通过效应的关系。方法选取2023年1~8月在聊城市人民医院进行治疗的大血管闭塞型AIS患者136例,进行机械取栓根据是否获得首次通过效应将其分为首次通过组(n=41)以及未首次通过组(n=95)。收集所有患者的临床资料并检测血清PTX3的水平。对所有患者进行三个月的随访,根据改良Rankin评分判定预后情况。采用多因素Logistic回归法分析大血管闭塞型AIS患者首次通过效应的影响因素,采用受试者工作特征(ROC)曲线分析血清PTX3对大血管闭塞型AIS患者首次通过效应的预测价值。结果首次通过组的预后情况良好率高于未首次通过组(56.10%vs 36.84%),差异具有统计学意义(χ^(2)=4.341,P=0.037)。与未首次通过组相比,首次通过组的年龄(59.38±5.12岁)、高血压比例(43.90%)、入院美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分(13.58±4.16分)以及血清PTX3水平(1.21±0.32 ng/L)均低于未首次通过组(63.45±7.61岁,65.26%,15.75±5.13分,1.71±0.41ng/L),差异具有统计学意义(t/χ^(2)=3.129,5.395,2.389,6.944,均P<0.05)。经多因素Logistic回归法分析显示,年龄较小[OR(95%CI):0.859(0.752~0.982)]、无高血压[OR(95%CI):0.672(0.480~0.942)]、入院NIHSS评分下降[OR(95%CI):0.867(0.781~0.962)]以及血清PTX3水平下降[OR(95%CI):0.558(0.326~0.954)]均是大血管闭塞型AIS患者机械取栓首次通过效应的影响因素(Waldχ^(2)值=4.997,5.238,7.280,4.543,均P<0.05)。经过三个月随访,预后良好组的血清PTX3水平低于预后不良组(1.28±0.39 ng/L vs 1.65±0.43 ng/L),差异具有统计学意义(t=5.111,P<0.001)。经ROC分析显示,血清PTX3对大血管闭塞型AIS患者首次通过效应和不良预后的预测价值较高,曲线下面积(95%CI)分别为0.785(0.703~0.866)和0.734(0.651~0.806),最佳临界值分别为1.38 ngObjective To investigate the relationship between pentraxin 3(PTX3)and first-pass effect of mechanical thrombectomy in patients with large vessel occlusion acute ischemic stroke(AIS).Methods A total of 136 AIS patients with large vessel occlusion treated in Liaocheng People’s Hospital from January to August 2023 were selected,and they were divided into first pass group(n=41)and non-first pass group(n=95)according to whether they achieved first-pass effect of mechanical thrombectomy.The clinical data of all patients were collected and the serum PTX3 levels were detected.All patients were followed up for 3 months,and the prognosis was evaluated according to the modified Rankin score.Multivariate Logistic regression was used to analyze the influencing factors of first-pass effect in AIS patients with large vessel occlusion.ROC analysis was used to analyze the predictive value of serum PTX3 for first-pass effect in AIS patients with large vessel occlusion.Results The rate of good prognosis in the first pass group was higher than that in the non-first pass group(56.10%vs 36.84%),and the difference was significant(χ^(2)=4.341,P=0.037).Compared with the non-first pass group,the age(59.38±5.12 years),the proportion of hypertension(43.90%),the National Institutes of Health Stroke Scale(NIHSS)score at admission(13.58±4.16 score)in the first pass group and serum PTX3 level(1.21±0.32 ng/L)in the first pass group were lower than those in the failed group(63.45±7.61 years,65.26%,15.75±5.13 score,1.71±0.41 ng/L),and the differences were significant(t/χ^(2)=3.129,5.395,2.389,6.944,all P<0.05).Multivariate Logistic regression analysis showed that younger age[OR(95%CI):0.859(0.752~0.982)],no hypertension[OR(95%CI):0.672(0.480~0.942)],decreased NIHSS score at admission[OR(95%CI):0.867(0.781~0.962)]and decreased serum PTX3 levels[OR(95%CI):0.558(0.326~0.954)]were the influencing factors of the first-pass effect of mechanical thrombectomy in AIS patients with large vessel occlusion(Waldχ^(2)=4.997,5.238,7.280,4.543,all P<0

关 键 词：急性缺血性脑卒中 正五聚蛋白3 机械取栓 首次通过效应 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R392.11[医药卫生—临床医学]