急性缺血性脑卒中患者血清TSG-6、ABCA1预测溶栓后出血转化的价值及与短期预后的关系  

The value of serum TSG-6 and ABCA1 in predicting hemorrhagic transformation after thrombolysis and its relationship with short term prognosis in patients with acute ischemic stroke

作　　者：陈慧昱 鄂盈 任鲜卉 卫婧雅 虢瑾 Chen Huiyu;E Ying;Ren Xianhui;Wei Jingya;Guo Jin(Department of Laboratory,The First Affiliated Hospital of Air Force Military Medical University,Shaanxi Province,Xi’an 710032,China;不详)

机构地区：[1]空军军医大学第一附属医院检验科,西安710032 [2]空军军医大学第一附属医院病理科,西安710032 [3]空军军医大学第一附属医院神经内科,西安710032

出　　处：《疑难病杂志》2024年第9期1037-1042,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：陕西省卫生健康委卫生健康科研项目(2022D0014)。

摘　　要：目的急性缺血性脑卒中(AIS)患者血清肿瘤坏死因子α刺激基因6(TSG-6)、ATP结合盒亚家族A成员1(ABCA1)预测溶栓后出血转化(HT)的价值及与短期预后的关系。方法选取2021年1月—2023年10月空军军医大学第一附属医院神经内科接受静脉溶栓的AIS患者185例(AIS组)和同期健康体检者100例(健康对照组),AIS患者根据溶栓后是否发生HT分为HT亚组56例和非HT亚组129例,根据溶栓后3个月改良Rankin量表(mRS)评分分为不良预后亚组47例和良好预后亚组138例。采用酶联免疫吸附法检测血清TSG-6、ABCA1水平;多因素Logistic回归分析AIS患者溶栓后HT的影响因素,Pearson法分析血清TSG-6、ABCA1水平与AIS患者mRS评分的相关性,受试者工作特征(ROC)曲线分析二者对AIS患者溶栓后HT的预测价值。结果与健康对照组比较,AIS组血清TSG-6水平升高,ABCA1水平降低(t/P=12.178/<0.001、25.944/<0.001)。185例AIS患者溶栓后HT发生率为30.27%(56/185)。与非HT亚组比较,HT亚组血清TSG-6水平升高,ABCA1水平降低(t/P=7.607/<0.001、6.784/<0.001)。随访3个月,185例AIS患者溶栓后预后不良发生率为25.41%(47/185)。与良好预后亚组比较,不良预后亚组血清TSG-6水平升高,ABCA1水平降低(t/P=6.876/<0.001、6.470/<0.001)。AIS患者mRS评分与血清TSG-6水平呈正相关(r/P=0.693/<0.001),与ABCA1水平呈负相关(r/P=-0.671/<0.001)。美国国立卫生研究院卒中量表评分(NIHSS)增加、心源性栓塞、TSG6升高为AIS患者溶栓后HT的独立危险因素[OR(95%CI)=1.071(1.023~1.121)、2.907(1.077~7.845)、2.075(1.466~2.938)],ABCA1升高为保护因素[OR(95%CI)=0.900(0.858~0.945)]。血清TSG-6、ABCA1水平及二者联合预测AIS患者溶栓后HT的AUC分别为0.802、0.786、0.880,二者联合的AUC大于血清TSG-6、ABCA1水平单独预测(Z/P=3.161/0.002、3.298/0.001)。结论AIS患者血清TSG-6水平升高和ABCA1水平降低,与溶栓后HT发生和短期预后不良相关,血清TSG-6、ABCA1水平联合对AIObjective To investigate the value of serum tumor necrosis factorαstimulated gene 6(TSG-6)and ATP binding cassette subfamily A member 1(ABCA1)in predicting hemorrhagic transformation(HT)after thrombolysis and their relationship with short term prognosis in patients with acute ischemic stroke(AIS).Methods From January 2021 to October 2023,185 patients with AIS who received intravenous thrombolysis in the Department of Neurology,First Affiliated Hospital of Air Force Medical University(AIS group)and 100 healthy subjects(control group)were selected.AIS patients were divided into HT subgroup(56 cases)and non-HT subgroup(129 cases)according to whether HT occurred after thrombolysis.According to the modified Rankin scale(mRS)at 3 months after thrombolysis,AIS patients were divided into poor prognosis subgroup(47 cases)and good prognosis subgroup(138 cases).Serum TSG-6 and ABCA1 levels were detected by enzyme linked immunosorbent assay.Multivariate Logistic regression analysis was used to analyze the factors of HT after thrombolysis in AIS patients.Pearson method and ROC curve were used to analyze the correlation between serum TSG-6,ABCA1 levels and mRS score of AIS patients and their predictive value for HT after thrombolysis in AIS patients.Results Compared with the control group,the serum TSG-6 level in the AIS group increased and the ABCA1 level decreased(t/P=12.178/<0.001,25.944/<0.001).The incidence of HT in 185 AIS patients after thrombolysis was 30.27%(56/185).Compared with the non-HT subgroup,the serum TSG-6 level was increased and the ABCA1 level was decreased in the HT subgroup(t/P=7.607/<0.001,6.784/<0.001).After 3 months of follow up,the incidence of poor prognosis after thrombolysis in 185 AIS patients was 25.41%(47/185).Compared with the good prognosis subgroup,the serum TSG-6 level was increased and the ABCA1 level was decreased in the poor prognosis subgroup(t/P=6.876/<0.001,6.470/<0.001).The mRS score of AIS patients was positively correlated with serum TSG-6 level and negatively correlated with ABCA1

关 键 词：急性缺血性脑卒中 肿瘤坏死因子α刺激基因6 ATP结合盒亚家族A成员1 出血转化 短期预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]