急性脑梗死患者血清可溶性髓样细胞触发受体2、P-选择素及大脑中动脉高密度征长度与溶栓效果及近期预后的相关性研究  

Relationships of serum soluble triggering receptor expressedon myeloid cells-2, P-selectin and length of hyperdensemiddle cerebral artery sign with effect of thrombolysisand short-term prognosis in patients with acutecerebral infarction

作　　者：李可 李天民 苗果 柳秋 LI Ke;LI Tianmin;MIAO Guo;LIU Qiu(Department of Neurology,Nanshi Hospital of Nanyang of Henan Provine,Nanyang,Henan,473000)

机构地区：[1]河南省南阳南石医院神经内科,河南南阳473000

出　　处：《实用临床医药杂志》2025年第1期83-88,共6页Journal of Clinical Medicine in Practice

基　　金：河南省医学科技攻关计划项目(LHGJ202203627)。

摘　　要：目的 分析急性脑梗死(ACI)患者血清可溶性髓样细胞触发受体2(sTREM2)、P-选择素及大脑中动脉高密度征(HMCAS)长度与溶栓效果及近期预后的关系。方法 将109例ACI行溶栓治疗患者根据溶栓效果分为无效组(n=27)和有效组(n=82)。治疗后90 d,根据改良Rankin评分(mRS)将109例患者分为预后良好组(n=78)和预后不良组(n=31)。比较2组患者的一般资料、美国国立卫生研究院卒中量表(NIHSS)、血清sTREM2水平、P-选择素水平及HMCAS长度。应用二元Logistic回归模型分析ACI患者溶栓治疗效果的影响因素;采用Pearson相关系数分析实验室指标与ACI患者mRS的相关性;绘制受试者工作特征(ROC)曲线分析血清sTREM2、P-选择素及HMCAS长度对患者预后的预测价值。结果 有效组入院时NIHSS评分低于无效组,差异有统计学意义(P<0.01)。有效组血清sTREM2、P-选择素水平低于无效组,HMCAS长度短于无效组,差异均有统计学意义(P<0.01)。二元Logistic回归分析结果显示,NIHSS评分>15分(OR=2.649,95%CI:1.357~5.167)、血清sTREM2水平高于均值(OR=2.686, 95%CI:1.860~8.786)、P-选择素水平高于均值(OR=4.043, 95%CI:1.860~8.786)以及HMCAS长度>1 mm(OR=3.827, 95%CI:1.740~8.414)均为ACI患者溶栓治疗效果不佳的危险因素(P<0.01)。预后良好组血清sTREM2、P-选择素水平低于预后不良组,HMCAS长度短于预后不良组,差异均有统计学意义(P<0.01)。血清sTREM2、P-选择素及HMCAS长度与ACI患者溶栓治疗后mRS均呈正相关(r=0.686、0.597、0.662,P均<0.001)。血清sTREM2、P-选择素、HMCAS长度及3项指标联合预测ACI患者溶栓治疗预后的曲线下面积(AUC)分别为0.833、0.862、0.889、0.914,敏感度分别为0.806、0.742、0.806、0.742,特异度分别为0.923、0.897、0.936、0.949。结论 ACI患者溶栓治疗效果与入院时NIHSS评分、血清sTREM2水平、P-选择素水平及HMCAS长度有关,高水平血清sTREM2、P-选择素水平及长HMCAS可能增加ACI患者Objective To analyze the relationships of serum soluble triggering receptor expressed on myeloid cells-2(sTREM2),P-selectin and the length of hyperdense middle cerebral artery sign(HMCAS)with the effect of thrombolysis and short-term prognosis in patients with acute cerebral infarction(ACI).Methods A total of 109 ACI patients with thrombolytic therapy were divided into ineffective group(n=27)and effective group(n=82)based on thrombolysis outcomes.Ninety days after treatment,the 109 patients were further divided into good prognosis group(n=78)and poor prognosis group(n=31)according to the modified Rankin Scale(mRS).General information,the National Institutes of Health Stroke Scale(NIHSS)score,serum sTREM2 level,P-selectin levels,and HMCAS length were compared between the two groups. Binary Logistic regression model was usedto analyze the influencing factors of thrombolysis outcomes in ACI patients. Pearson correlation coefficient was calculated to analyze the correlation between laboratory indicators and mRS in ACI patients. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive values of serum sTREM2, P-selectin and HMCAS length for prognosis of patients. Results The NIHSS score at admission in the effective group was significantly lower than that in the ineffective group ( P < 0.01) . The serum sTREM2 and P-selectin levels as well as the HMCAS length in the effective group were significantly lower or shorter than those in the ineffective group ( P <0.01). The results of binary Logistic regression analysis showed that NIHSS score>15 (OR=2.649, 95%CI, 1.357 to 5.167) , serum sTREM2 above the mean level (OR=2.686, 95%CI, 1.860 to 8.786), P-selectin above the mean level (OR=4.043, 95%CI,1.860 to 8.786), and HMCAS length > 1 mm (OR=3.827, 95%CI, 1.740 to 8.414) were all risk factors for poor thrombolysis outcomes in ACI patients ( P <0.01). The serum sTREM2 and P-selectin levels as well as the HMCAS length in the good prognosis group were significantly lower or shorter than those in the p

关 键 词：急性脑梗死 可溶性髓样细胞触发受体2 P-选择素 大脑中动脉高密度征 溶栓效果 近期预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R446.11[医药卫生—临床医学] R364.1