Lp-PLA2、sTfR、P2X7R水平与急性脑梗死患者静脉溶栓后认知功能及预后不良的关系  

Relationship between the Level of Lp-PLA2,sTfR,and P2X7R and Cognitive Function and Poor Prognosis in Patients with Acute Cerebral Infarction after Intravenous Thrombolysis

作　　者：王秀杰 赵晓晶 李敏 郑富霞 熊鑫 范海燕 WANG Xiujie;ZHAO Xiaojing;LI Min;ZHENG Fuxia;XIONG Xin;FAN Haiyan(Department of Neurology,Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,China)

机构地区：[1]华北理工大学附属医院神经内科,河北省唐山市063000

出　　处：《实用心脑肺血管病杂志》2025年第1期61-66,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：2023年度河北省医学科学研究课题计划(20231275)。

摘　　要：目的探讨脂蛋白相关磷脂酶A2(Lp-PLA2)、可溶性转铁蛋白受体(sTfR)、嘌呤能离子通道型受体7(P2X7R)水平与急性脑梗死(ACI)患者静脉溶栓后认知功能及预后不良的关系。方法回顾性选取2022年1月—2024年1月华北理工大学附属医院收治的ACI 118例作为研究对象,根据静脉溶栓后3个月蒙特利尔认知评估量表(MoCA)评分将患者分为认知正常组(MoCA评分≥26分,n=62)和认知障碍组(MoCA评分<26分,n=56);另根据静脉溶栓后3个月改良Rankin量表(mRS)评分将患者分为预后良好组(mRS评分≤2分,n=77)和预后不良组(mRS评分>2分,n=41)。患者均接受阿替普酶静脉溶栓治疗。收集患者的临床资料,采用Spearman秩相关分析探讨Lp-PLA2、sTfR、P2X7R水平与ACI患者静脉溶栓后MoCA评分的相关性;采用多因素Logistic回归分析探讨ACI患者静脉溶栓后预后不良的影响因素,绘制ROC曲线以分析Lp-PLA2、sTfR、P2X7R水平及三者联合对ACI患者静脉溶栓后预后不良的预测价值。结果认知障碍组梗死面积大于认知正常组,TG、Lp-PLA2、P2X7R水平高于认知正常组,HDL-C、sTfR水平低于认知正常组(P<0.05)。Spearman秩相关分析结果显示,Lp-PLA2、P2X7R水平与ACI患者静脉溶栓后MoCA评分均呈负相关,sTfR水平与其MoCA评分呈正相关(P=0.001)。预后不良组梗死面积大于预后良好组,Lp-PLA2、P2X7R水平高于预后良好组,sTfR水平低于预后良好组(P<0.05)。多因素Logistic回归分析结果显示,梗死面积增大、Lp-PLA2水平升高、P2X7R水平升高是ACI患者静脉溶栓后预后不良的独立危险因素,sTfR水平升高是其保护因素(P<0.05)。ROC曲线分析结果显示,Lp-PLA2、sTfR、P2X7R水平及三者联合预测ACI患者静脉溶栓后预后不良的曲线下面积(AUC)分别为0.769[95%CI(0.681~0.857)]、0.801[95%CI(0.721~0.880)]、0.809[95%CI(0.719~0.899)]、0.917[95%CI(0.868~0.966)],三者联合预测ACI患者静脉溶栓后预后不良的AUC分别大于Lp-PLA2、sObjective To investigate the relationship between the levels of lipoprotein-associated phospholipase A2(Lp-PLA2),soluble transferrin receptor(sTfR),purinergic ligand-gated ion channel 7 receptor(P2X7R)and cognitive function and poor prognosis in patients with acute cerebral infarction(ACI)after intravenous thrombolysis.Methods A total of 118 patients with ACI admitted to Affiliated Hospital of North China University of Science and Technology from January 2022 to January 2024 were retrospectively selected as the research subjects.According to Montreal Cognitive Assessment Scale(MoCA)score at 3-month after intravenous thrombolysis,patients were divided into the cognitive normal group(MoCA score≥26,n=62)and the cognitive impaired group(MoCA score<26,n=56);and according to the modified Rankin Scale(mRS)score at 3-month after intravenous thrombolysis,patients were divided into the good prognosis group(mRS score≤2,n=77)and the poor prognosis group(mRS score>2,n=41).Patients were treated with alteplase for intravenous thrombolysis.The clinical data of the patients were collected.Spearman rank correlation analysis was used to investige the correlation between the levels of Lp-PLA2,sTfR,P2X7R and MoCA score.Multivariate Logistic regression analysis was used to explore the influencing factors of poor prognosis in patients with ACI after intravenous thrombolysis.ROC curve was drawn to explore the predictive value of the levels of Lp-PLA2,sTfR,P2X7R and their combination for poor prognosis in patients with ACI after intravenous thrombolysis.Results The infarct area of the cognitive impaired group was larger than that of the cognitive normal group,the levels of TG,Lp-PLA2,and P2X7R were higher than those of the cognitive normal group,and the levels of HDL-C and sTfR were lower than those of the cognitive normal group(P<0.05).Spearman rank correlation analysis showed that,in patients with ACI after intravenous thrombolysis,there were negative correlation between the levels of Lp-PLA2,P2X7R and MoCA score,and there was a po

关 键 词：脑梗死 静脉溶栓 脂蛋白相关磷脂酶A2 可溶性转铁蛋白受体 嘌呤能离子通道型受体7 认知功能 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]