血清黑素瘤缺乏因子2水平预测急性脑梗死患者行阿替普酶静脉溶栓后发生早期神经功能恶化的价值  

Value of serum absent in melanoma 2 expressionlevel in predicting occurrence of early neurologicaldeterioration after alteplase intravenous thrombolysisin patients with acute cerebral infarction

作　　者：王凡 王向阳 赵建华[1] WANG Fan;WANG Xiangyang;ZHAO Jianhua(Department of Neurology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang,Henan,453000;Department of Neurosurgery,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang,Henan,453000)

机构地区：[1]新乡医学院第一附属医院神经内科,河南新乡453000 [2]新乡医学院第一附属医院神经外科,河南新乡453000

出　　处：《实用临床医药杂志》2025年第1期13-17,22,共6页Journal of Clinical Medicine in Practice

基　　金：河南省科技厅科技攻关计划国际合作项目(232102521029);2020年度新乡医学院第一附属医院青年培育基金项目(QN-2020-B09)。

摘　　要：目的 探讨急性脑梗死(ACI)患者血清黑素瘤缺乏因子2(AIM2)表达水平与病情严重程度的相关性,并评估AIM2预测ACI患者阿替普酶静脉溶栓治疗后发生早期神经功能恶化(END)的价值。方法 选取150例ACI患者为ACI组,另选取30例健康体检者为对照组。ACI患者入院时根据美国国立卫生研究院卒中量表(NIHSS)评分分为轻度组、中度组和重度组,根据静脉溶栓治疗后END情况分为END组和非END组。收集ACI患者的临床资料;采用酶联免疫吸附试验(ELISA)测定血清AIM2表达水平;采用Logistic回归模型分析ACI患者静脉溶栓治疗后发生END的影响因素;绘制受试者工作特征(ROC)曲线分析血清AIM2表达水平预测ACI患者静脉溶栓治疗后发生END的临床效能。结果 ACI组、对照组血清AIM2表达水平分别为(58.29±5.97)、(36.81±3.03) ng/mL,差异有统计学意义(t=43.23,P<0.05)。轻度组、中度组和重度组血清AIM2表达水平逐渐升高,两两比较差异均有统计学意义(P<0.01)。ACI患者血清AIM2表达水平与NIHSS评分呈正相关(r=0.941,P<0.01)。END组NIHSS评分、入院到溶栓时间、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白、AIM2水平高于或长于非END组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,NIHSS评分(OR=3.871,P<0.001)、入院到溶栓时间(OR=2.885,P=0.002)、LDL-C(OR=3.118,P<0.001)和AIM2(OR=3.761,P<0.001)均为ACI患者静脉溶栓术后发生END的影响因素。ROC曲线结果显示,ACI患者入院时血清AIM2表达水平预测静脉溶栓术后发生END的曲线下面积(AUC)为0.911;当AIM2截断值为66.56 ng/mL时,诊断敏感度和特异度分别为91.23%和90.15%。结论 ACI患者血清AIM2表达水平显著升高;AIM2表达水平预测ACI患者静脉溶栓治疗后发生END具有一定优势。Objective To investigate the correlation between the expression level of absent in melanoma 2(AIM2)in serum and the severity of acute cerebral infarction(ACI),and to evaluate the value of AIM2 in predicting early neurological deterioration(END)after intravenous thrombolysis with alteplase in ACI patients.Methods A total of 150 ACI patients were enrolled in ACI group,and another 30 healthy individuals physical examination were selected as control group.ACI patients were further divided into mild,moderate and severe groups according to the National Institutes of Health Stroke Scale(NIHSS)score at admission,and they were also divided into END and non-END groups based on the occurrence of END after intravenous thrombolysis.Clinical materials of ACI patients were collected;the expression level of serum AIM2 was measured by enzyme-linked immunosorbent assay(ELISA);the Logistic regression analysis was performed to identify the factors influencing END after intravenous thrombolysis in ACI patients;the receiver operating characteristic(ROC)curve was plotted to analyze the clinical performance of serum AIM2 expression level in predicting END after intravenous thrombolysis in ACI patients. Results The serum AIM2 expression level in the ACI group and thecontrol group was (58.29±5.97) and (36.81±3.03) ng/mL respectively, with a significant between-group difference ( t =43.23, P <0.05). The serum AIM2 expression level gradually increased in the mild, moderate and severe groups, with significant differences between each pair of groups ( P <0.01). The serum AIM2 expression level in ACI patients was positively correlated with the NIHSS score ( r =0.941, P <0.01). The NIHSS score, time from admission to thrombolysis, low-density lipoprotein cholesterol (LDL-C), C-reactive protein, and AIM2 level in the END group were significantly higher or longer than those in the non-END group ( P <0.05). The results of multivariate Logistic regression analysis showed that NIHSS score (OR=3.871, P <0.001), time from admission to thrombolysis (

关 键 词：急性脑梗死 黑素瘤缺乏因子2 早期神经功能恶化 阿替普酶 静脉溶栓治疗 

分 类 号：R743[医药卫生—神经病学与精神病学] R741.04[医药卫生—临床医学] R319