老年营养风险指数联合UCH-L1、iNOS、血清铜对脑卒中后神经功能预后研究  

Study on the prognosis of post⁃stroke neurological function using the geriatric nutritional risk index combined with UCH⁃L1,iNOS,and serum copper

作　　者：叶丽媛 严平[1] 黄飞波[1] YE Li⁃yuan;YAN Ping;HUANG Fei⁃bo(Department of Geriatrics,Lishui People’s Hospital,Lishui 323000,China)

机构地区：[1]丽水市人民医院老年医学科,浙江丽水323000

出　　处：《哈尔滨医科大学学报》2024年第5期493-499,共7页Journal of Harbin Medical University

基　　金：浙江省中医药科技计划(2024ZL1301)

摘　　要：目的 探究老年营养风险指数(geriatric nutritional risk index, GNRI)联合泛素羧基末端水解酶L1(ubiquitin c-terminal hydrolase L1,UCH-L1)、诱导型一氧化氮合酶(inducible nitric oxide synthase, iNOS)、血清铜预测脑卒中后神经功能的效能。方法 回顾性收集丽水市人民医院2020年3月~2023年1月住院的缺血性脑卒中患者82例,根据卒中后3个月改良Rankin量表(modified Rankin Scale, mRS)评分将研究对象分为预后良好组(0~2分,n=54)和预后不良组(3分及以上,n=28),检测并比较两组GNRI指数[高营养风险(Q1)、中营养风险(Q2)、低营养风险(Q3)、无营养风险(Q4)]、UCH-L1、iNOS及血清铜水平。采用Pearson检验分析GNRI指数与UCH-L1、iNOS及血清铜水平的相关性,通过多因素Logistic回归筛选对脑卒中后患者神经功能预后的危险因素,采用受试者工作特征曲线(receiver operating characteristic curve, ROC曲线)判断GNRI指数、UCH-L1、iNOS及血清铜水平对脑卒中后患者神经功能的预后价值。结果 预后不良组与预后良好组mRS及NIHSS评分、GNRI营养风险评分、UCH-L1、iNOS及血清铜水平比较,差异均有统计学意义(P<0.05);Pearson相关性分析结果显示,UCH-L1、iNOS及血清铜水平与GNRI评分均成负相关(r=-0.282、-0.473和-0.428,P<0.05);多因素Logistic回归分析结果显示,GNRI评分高[OR=0.951(95%CI:0.908,0.995)]、GNRI分级高[OR=0.640(95%CI:0.414,0.989)]是卒中后神经功能预后不良发生的独立保护因素(P<0.05);mRS评分高[OR=1.985(95%CI:1.042,3.781)]、初始NIHSS评分高[OR=1.442(95%CI:1.070,1.943)]、出院NIHSS评分高[OR=1.431(95%CI:1.069,1.916)]、UCH-L1水平高[OR=21.619(95%CI:2.047,228.270)]、iNOS水平高[OR=1.165(95%CI:1.020,1.330)]及血清铜水平高[OR=1.004(95%CI:1.000,1.008)]均是卒中后神经功能预后不良发生的独立危险因素(P<0.05);联合检测AUC面积为0.962,95%CI为(0.905,1),敏感性为89.7%,95%CI为(78.6,100),特异性为98.1%,95%CI为(0.950,0.952),准确度�Objective To investigate the efficacy of the geriatric nutritional risk index(GNRI)combined with ubiquitin c⁃terminal hydrolase L1(UCH⁃L1),inducible nitric oxide synthase(iNOS),and serum copper levels in predicting post⁃stroke neurological outcomes in the elder⁃ly.Methods A retrospective analysis was conducted on 82 patients with ischemic stroke who were admitted to the Lishui People’s Hospital from March 2020 to January 2023.Based on the 3⁃month post⁃stroke modified Rankin Scale(mRS)scores,patients were classified into a good prognosis group(0~2 points,n=54)and a poor prognosis group(3 points or above,n=28).The GNRI(high nutritional risk(Q1),medium nutritional risk(Q2),low nutritional risk(Q3),no nutritional risk(Q4)),UCH⁃L1,iNOS,and serum copper levels were meas⁃ured and compared between the two groups.The Pearson test was used to analyze the correla⁃tion between GNRI and UCH⁃L1,iNOS,and serum copper levels.Multivariate logistic regres⁃sion was employed to screen for risk factors affecting post⁃stroke neurological outcomes.Receiv⁃er operating characteristic(ROC)curve was used to evaluate the prognostic value of GNRI,UCH⁃L1,iNOS,and serum copper levels for post⁃stroke neurological outcomes.Results Comparison of mRS and NIHSS scores,GNRI nutritional risk scores,UCH⁃L1,iNOS,and ser⁃um copper levels between the poor prognosis group and the good prognosis group showed statis⁃tically significant differences(P<0.05).Pearson correlation analysis results showed that UCH⁃L1,iNOS,and serum copper levels were negatively correlated with GNRI scores(r=-0.282,-0.473,and-0.428,P<0.05).Multivariate Logistic regression analysis results indicated that higher GNRI scores(OR=0.951(95%CI:0.908,0.995))and higher GNRI grading(OR=0.640(95%CI:0.414,0.989))were independent protective factors for poor neurological prognosis after stroke(P<0.05).Higher mRS scores(OR=1.985(95%CI:1.042,3.781)),higher initial NIHSS scores(OR=1.442(95%CI:1.070,1.943)),higher discharge NIHSS scores(OR=1.431(95%CI:1.069,1.

关 键 词：老年营养风险指数 泛素羧基末端水解酶L1 诱导型一氧化氮合酶 血清铜 预后效能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]