血尿素氮联合二氧化碳结合力预测急性缺血性卒中静脉溶栓患者短期预后的临床价值  

Clinical value of blood urea nitrogen combined with carbon dioxide binding power in predicting short-term outcome of patients acute ischemic stroke undergoing intravenous thrombolysis

作　　者：朱康锋 赵斌 冯涛[3] ZHU Kangfeng;ZHAO Bin;FENG Tao(Graduate School of Xinxiang Medical University,Xinxiang,Henan 453003,China;School of Forensic Medicine,Xinxiang Medical University,Xinxiang,Henan 453003,China;Fifth Department of Neurology,First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 453000,China)

机构地区：[1]新乡医学院研究生院,河南新乡453003 [2]新乡医学院法医学院,河南新乡453003 [3]南阳医学高等专科学校第一附属医院神经内科五病区,河南南阳453000

出　　处：《重庆医学》2024年第23期3570-3574,3580,共6页Chongqing Medical Journal

基　　金：国家重点研发计划项目(2017YFC1310400)。

摘　　要：目的探讨血尿素氮(BUN)联合二氧化碳结合力(CO_(2)-CP)预测急性缺血性卒中(AIS)静脉溶栓患者短期预后的临床价值。方法回顾性分析2023年1月至2024年1月在南阳医学高等专科学校第一附属医院神经内科使用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的238例AIS患者病历资料,收集一般资料和实验室检测结果,根据第90天改良Rankin量表(mRS)结果,分为预后良好组(mRS<3分,n=157)、预后不良组(mRS≥3分,n=81)。比较两组静脉溶栓前WBC、红细胞计数(RBC)、PLT、Na^(+)、K^(+)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白-胆固醇(HDL-C)、纤维蛋白原(Fib)、D-二聚体、同型半胱氨酸(HCY)、BUN、血肌酐(Cr)、血尿酸(UA)、UA/Cr、CO_(2)-CP水平差异,采用多因素logistic回归分析AIS静脉溶栓治疗患者预后不良的危险因素,绘制受试者工作特征(ROC)曲线评价相应指标对AIS患者静脉溶栓治疗患者短期预后的预测价值。结果两组入院NIHSS评分、血糖、BUN、CO_(2)-CP水平比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,BUN(OR=1.308,95%CI:1.119~1.528)和CO_(2)-CP(OR=0.676,95%CI:0.589~0.776)是AIS静脉溶栓治疗患者短期预后的独立影响因素(P<0.05)。ROC曲线分析结果显示,BUN、CO_(2)-CP联合评价AIS静脉溶栓治疗患者短期预后不良的曲线下面积(AUC)为0.850,95%CI为0.800~0.901,灵敏度为79.0%,特异度为82.8%,具有较好的预测价值。结论BUN联合CO_(2)-CP预测AIS静脉溶栓治疗患者短期预后临床价值较高。Objective To explore the clinical value of blood urea nitrogen(BUN)combined with carbon dioxide binding power(CO_(2)-CP)in predicting the short-term prognosis in the patients with acute ischemic stroke(AIS)undergoing intravenous thrombolysis.Methods The medical case data of 238 patients with AIS treated by recombinant tissue plasminogen activator(rt-PA)intravenous thrombolysis in the neurology department of the First Affiliated Hospital of Nanyang Medical College from January 2023 to January 2024 were retrospectively analyzed.The general data and laboratory test results were collected.The general data and laboratory detection results were collected.According to the results of modified Rankin Scale(mRS)on 90 d,the patients were divided into the good prognosis group(mRS<3 points,157 cases)and poor prognosis group(mRS≥3 points,81 cases).The levels of WBC count,RBC count,PLT,Na^(+),K^(+),TC,TG,HDL-C,Fib,D-dimer,HCY,BUN,Cr,UA,UA/Cr ratio and CO_(2)-CP before intravenous thrombolysis were compared between the two groups.The multivariate logistic regression was used to analyze the risk factors of poor prognosis in the patients with AIS intravenous thrombolysis treatment.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of the corresponding indicators in the short-term prognosis of the AIS patients with intravenous thrombolysis treatment.Results The NIHSS score,Glu,BUN and CO_(2)-CP levels at admission had statistically significant difference between the two groups(P<0.05).The multivariate logistic regression analysis results showed that BUN(OR=1.308,95%CI:1.119-1.528)and CO_(2)-CP(OR=0.676,95%CI:0.589-0.776)were the independently influencing factors for the short-term prognosis in the patients with AIS intravenous thrombolysis treatment.The ROC curve analysis results showed that the area under the curve(AUC)of BUN and CO_(2)-CP combination in the evaluation of short-term poor prognosis in the patients with AIS intravenous thrombolysis treatment was 0.850,the 95%CI was 0.800-0.9

关 键 词：血尿素氮 二氧化碳结合力 急性缺血性卒中 静脉溶栓 短期预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]