APACHEⅣ评分、NTproBNP、LP-PLA2水平变化对老年出血性脑卒中患者预后转归的评估价值  

Evaluation value of APACHEⅣscore,NTproBNP and LP-PLA2levels in prognosis of elderly patients with hemorrhagic stroke

作　　者：侯璐 石妍 李国庆 闫美霞 杨凯[1] HOU Lu;SHI Yan;LI Guoqing;YAN Meixia;YANG Kai(Beijing Rehabilitation Hospital Affiliated to Capital Medical University Elderly Rehabilitation Center,Beijing100144,China)

机构地区：[1]首都医科大学附属北京康复医院老年康复中心,北京100144

出　　处：《中国实验诊断学》2025年第1期1-6,共6页Chinese Journal of Laboratory Diagnosis

基　　金：北京市医院管理局重点医学专业发展计划建设项目(ZYLL202136)。

摘　　要：目的分析急性生理学与慢性健康状况(APACHEⅣ)评分、N末端脑钠肽前体(NTproBNP)、脂蛋白相关性磷脂酶A2(LP-PLA2)水平变化对老年出血性脑卒中(HS)患者预后转归的评估价值。方法选取2022年1月—2023年8月首都医科大学附属北京康复医院收治的98例老年HS患者,于治疗前选取全自动免疫透射比浊法检测NT-proBNP水平;选取酶联免疫吸附法检测LP-PLA2水平,选取APACHEⅣ评分评估患者病情严重程度。给予患者持续生命体征监测、控制血压、血糖、止血、脑水肿,保证营养和维持水电解质平衡、降温等对症治疗。采用电话、上门随访6个月,选用改良Rankin评分量表(MRS)评估患者预后状况,将MRS评分≤2分纳入预后良好组,将MRS评分3~6分纳入预后不良组。对比预后不良组和预后良好组患者基础资料,分析APACHEⅣ评分、NTproBNP、LPPLA2水平评估老年HS患者预后不良的影响因素及预测价值。结果98例老年HS患者,预后不良有20例,占比20.41%。预后不良组NIHSS评分、APACHEⅣ评分、NTproBNP、LP-PLA2水平均高于预后良好组(P<0.05)。经Logistic回归方程分析(引入水准为0.05,排除水准为0.10),结果显示:NIHSS评分[OR=1.822(95%CI:1.352,2.456)]、APACHEⅣ评分[OR=1.180(95%CI:1.091,1.276)]、NTproBNP水平[OR=1.013(95%CI:1.007,1.019)]、LP-PLA2水平[OR=1.034(95%CI:1.016,1.052)]是预测老年HS患者预后不良的危险因素(P<0.05)。经ROC曲线分析,NIHSS评分、APACHEⅣ评分、NTproBNP、LP-PLA2、联合预测老年HS患者预后不良的灵敏度分别为65.00%、80.00%、70.00%、65.00%、90.00%,特异度分别为73.10%、71.80%、73.10%、76.90%、56.40%。NIHSS评分、APACHEⅣ评分、NTproBNP、LP-PLA2联合预测老年HS患者预后不良具有较高的价值(AUC为0.924)。结论对NIHSS评分、APACHEⅣ评分、NTproBNP、LP-PLA2水平是预测老年HS患者预后不良的危险因素,早期识别和纠正可逆因素有助于改善老年HS患者预后不良。Objective To evaluate the value of acute physiology and Chronic health status(APACHEⅣ)score,Nterminal brain natriuretic peptide precursor(NTproBNP)and lipoprotein-associated phospholipase A2(LP-PLA2)levels in the prognosis of elderly patients with hemorrhagic stroke(HS).Methods 98elderly patients with HS treated in Beijing Rehabilitation Hospital Affiliated to Capital Medical University Elderly Rehabilitation Center hospital from January 2022to August 2023were selected,and the level of NT-proBNP was detected by automatic immune transmission turbidimetry before treatment.Enzyme-linked immunosorbent assay(ELISA)was used to detect LP-PLA2levels,and APACHEⅣscore was used to evaluate the severity of patients’disease.Patients were given continuous vital signs monitoring,control of blood pressure,blood sugar,hemostasis,cerebral edema,nutrition,water and electrolyte balance,cooling and other symptomatic treatments.The patients were followed up by telephone and home for 6months,and the improved Rankin score scale(MRS)was used to evaluate the prognosis of the patients.MRS Score≤2points was included in the good prognosis group,and MRS Score 3-6points was included in the poor prognosis group.By comparing the basic data of patients in the poor prognosis group and the good prognosis group,the influencing factors and predictive value of APACHEⅣscore,NTproBNP and LP-PLA2levels in evaluating the poor prognosis of elderly patients with HS were analyzed.Results Of 98elderly patients with HS,20cases(20.41%)had poor prognosis.The levels of NIHSS score,APACHEⅣscore,NTproBNP and LP-PLA2in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Logistic regression equation analysis(introduction level 0.05,exclusion level 0.10)showed that:NIHSS score[OR=1.822(95%CI:1.352,2.456)],APACHEⅣscore[OR=1.180(95%CI:1.091,1.276)],NTproBNP level[OR=1.013(95%CI:1.007,1.019)],LP-PLA2level[OR=1.034(95%CI:1.016,1.052)]was a risk factor for predicting poor prognosis in elderly patients with HS(P<0.05).According

关 键 词：急性生理学与慢性健康 健康状况评分 N末端脑钠肽前体 脂蛋白相关性磷脂酶A2 老年出血性脑卒中 预后转归 

分 类 号：R54[医药卫生—心血管疾病]