H型高血压合并急性缺血性脑卒中患者血清GFAP的表达及对预后的预测价值  

Expression of serum GFAP in the patients with H-type hypertension combined with acute ischemic stroke and its prognostic value

作　　者：高海茸 苗婵婵 康乐乐 GAO Hairong;MIAO Chanchan;KANG Lele(Yan’an People’s Hospital,Yan’an 716000,China;Yanchang People’s Hospital,Yanchang 716000,China;Affiliated Hospital of Yan’an University,Yan’an 716000,China)

机构地区：[1]延安市人民医院,陕西延安716000 [2]延长县人民医院,陕西延长716000 [3]延安大学附属医院,陕西延安716000

出　　处：《中国实用神经疾病杂志》2024年第9期1083-1087,共5页Chinese Journal of Practical Nervous Diseases

基　　金：陕西省自然科学基础研究计划项目(编号:S2020-JC-QN-1129)。

摘　　要：目的探讨神经胶质纤维酸性蛋白(GFAP)在H型高血压合并急性缺血性脑卒中患者血清中的表达及与预后的预测价值。方法选取2019-01—2021-11延安市人民医院收治的157例H型高血压合并急性缺血性脑卒中患者为研究对象。根据改良Rankin量表(mRS)评分是否≥2分,分为预后良好组106例和预后不良组51例。搜集患者入院后的临床资料,包括年龄、性别、发病时间、吸烟史、饮酒史、高脂血症史、体重指数(BMI)、空腹血糖(FPG)、收缩压(SBP)、舒张压(DBP)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、肌酐(Cr)、总胆固醇(TC)、甘油三酯(TG)、肌酸激酶(CK)、高敏C反应蛋白(hs-CRP)和脑利钠肽(BNP)等。结果预后不良组与预后良好组血清GFAP水平分别为(95.21±6.22)ng/L、(65.94±5.69)ng/L。2组患者饮酒史、LDL-C、HDL-C、hs-CRP、BNP、GFAP比较差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,饮酒史、LDL-C≥1.80mmol/L、HDL-C≤0.74mmol/L、hs-CRP≥1.5 mg/L、BNP≥595.7μg/L、GFAP≥95.21 ng/L为患者预后不良的独立危险因素(P<0.05)。Pearson相关性分析显示,GFAP与神经功能损伤程度、脑梗死面积、mRS评分具有强相关性(r>0.800),饮酒史、LDL-C、HDL-C、hs-CRP、BNP与神经功能损伤程度、脑梗死面积、mRS评分无相关性(r<0.300)。GFAP表达阳性者平均总生存期为(13.65±2.68)个月,阴性者为(18.33±1.85)个月;阳性者无发病生存期为(9.65±2.68)个月,阴性者为(12.33±1.85)个月,二者相比差异有统计学意义(P<0.05)。血清GFAP预测患者预后不良的灵敏度85.3%,特异度86.7%,AUC为0.852,约登指数0.720。采用Hosmer-Lemeshow检验,χ^(2)=12.527,P=0.169,血清GFAP对患者预后不良的预测价值校准度与标准无明显偏倚,校准度良好。结论血清GFAP评价H型高血压合并急性缺血性脑卒中患者的预后状况具有重要作用。Objective To investigate the expression of serum GFAP in the patients with H-type hypertension combined with acute ischemic stroke and its prognostic value.Methods A total of 157 H-type hypertension combined with acute ischemic stroke patients admitted to Yan’an People’s Hospital from January 2019 to November 2021 were selected as the study subjects.According to the modified Rankin scale(mRS)score≤2 points,these patients were divided into the good prognosis group(mRS≤2 points)with 106 cases and the poor prognosis group(mRS>2 points)with 51 cases.Clinical data of patients after admission were collected,including age,gender,time of onset,smoking history,drinking history,history of hyperlipidemia,BMI,FPG,SBP,DBP,LDL-C,HDL-C,Cr,TC,TG,CK,hs-CRP and BNP,etc.Results The serum GFAP levels of the poor prognosis group and the good prognosis group were(95.21±6.22)ng/L and(65.94±5.69)ng/L,respectively.The drinking history,LDL-C,HDL-C,hs-CRP,BNP and GFAP in the two groups were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that a history of drinking,LDL-C≥1.80 mmol/L,HDL-C≤0.74 mmol/L,hs-CRP≥1.5 mg/L,BNP≥595.7μg/L,GFAP≥95.21 ng/L were independent risk factors for poor prognosis(P<0.05).Pearson correlation analysis showed that GFAP had a strong correlation with nerve function damage,cerebral infarction area,mRS score(r>0.800),drinking history,LDL-C,HDL-C,hs-CRP,BNP were all related to the degree of nerve function damage,cerebral infarction area,and mRS score(r<0.300).The average overall survival period of GFAP expression-positive individuals was(13.65±2.68)months,and which of negative individuals was(18.33±1.85)months;the positive individuals had a disease-free survival period of(9.65±2.68)months,and which of the negative individuals was(12.33±1.85)months,and the differences were all statistically significant(P<0.05).Based on the predictive value of serum GFAP expression for poor prognosis,the sensitivity was 85.3%,the specificity was 86.7%,the AUC was 0.852,and the

关 键 词：急性缺血性脑卒中 神经胶质纤维酸性蛋白 H型高血压 预后 预测价值 

分 类 号：R743.33[医药卫生—神经病学与精神病学]