Hcy与sTWEAK对前循环急性缺血性脑卒中患者脑白质病变的评估价值  

Evaluative value of Hcy and sTWEAK for white matter lesions in patients with anterior circulation acute ischemic stroke

作　　者：宋庆云 吴文娟 刘小娟 郭莹[2] 刘春玲[2] 王友明[2] SONG Qingyun;WU Wenjuan;LIU Xiaojuan;GUO Ying;LIU Chunling;WANG Youming(Handan People’s Hospital,Handan 056001,China;The Affiliated Hospital of Hebei University of Engineering,Handan 056001,China)

机构地区：[1]邯郸市人民医院,河北邯郸056001 [2]河北工程大学附属医院,河北邯郸056001

出　　处：《中国实用神经疾病杂志》2025年第3期326-330,共5页Chinese Journal of Practical Nervous Diseases

基　　金：2024年度河北省医学科学研究课题计划项目(编号:20242092)。

摘　　要：目的探究同型半胱氨酸(Hcy)及可溶性肿瘤坏死因子样弱凋亡诱导剂(sTWEAK)评估前循环急性缺血性脑卒中(AIS)患者脑白质病变(WML)的价值。方法回顾性分析2021-08—2023-08邯郸市人民医院收治的100例AIS患者资料,按是否并发WML将患者分为WML组(n=79)及非WML组(n=21),再按严重程度将WML患者分为轻度组(n=23)、中度组(n=30)及重度组(n=26)3个亚组。收集并比较WML组及非WML组基线资料及血清指标水平。采用Logistic回归分析AIS并发WML的危险因素。绘制ROC曲线分析血清Hcy及sTWEAK诊断AIS并发WML及评估WML严重程度的临床价值。结果WML组Hcy及sTWEAK水平高于非WML组(P<0.05)。三亚组Hcy及sTWEAK水平有统计学差异(P<0.05),血清Hcy及sTWEAK水平分布表现为轻度组<中度组<重度组(P<0.05)。高龄、合并高血压、高Hcy及高sTWEAK是AIS患者并发WML的独立危险因素(P<0.05)。Hcy联合sTWEAK诊断WML的AUC值(0.945)最大,高于Hcy(Z=2.989,P=0.003)及sTWEAK(Z=2.614,P=0.009)。Hcy联合sTWEAK诊断重度WML的AUC值最大(0.927),高于Hcy(Z=2.566,P=0.010)及sTWEAK(Z=1.537,P=0.124)。结论血清Hcy及sTWEAK能有效诊断AIS患者并发WML以及评估WML严重程度,血清Hcy及sTWEAK高表达是AIS患者并发WML的独立危险因素。Objective To investigate the evaluation value of homocysteine(Hcy)and soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)for white matter lesions(WML)in patients with acute ischemic stroke(AIS).Methods The data of 100 AIS patients admitted to Handan People’s Hospital from August 2021 to August 2023 were retrospectively analyzed.According to whether complicated with WML,the patients were divided into WML group(n=79)and non-WML group(n=21).According to the severity of WML,the patients were divided into three subgroups:mild group(n=23),moderate group(n=30)and severe group(n=26).Baseline data and serum indexes were collected and compared between the WML group and the non-WML group.Logistic regression was used to analyze the risk factors for AIS complicated with WML.ROC curves were drawn to analyze the clinical value of serum Hcy and sTWEAK in diagnosing of AIS complicated with WML and evaluating the severity of WML.Results The levels of Hcy and sTWEAK in the WML group were higher than those in the non-WML group(P<0.05).There were significant differences in Hcy and sTWEAK levels among the three subgroups(P<0.05),and the distribution of serum Hcy and sTWEAK levels was as follows:mild group<moderate group<severe group(P<0.05).Old age,hypertension,high Hcy and high sTWEAK were independent risk factors for WML in AIS patients(P<0.05).The AUC value(0.945)of Hcy combined with sTWEAK in WML diagnosis was maximum,which was higher than that of Hcy(Z=2.989,P=0.003)and sTWEAK(Z=2.614,P=0.009)alone.The AUC value(0.927)of Hcy combined with sTWEAK in the diagnosis of severe WML was the highest,which was higher than that of Hcy(Z=2.566,P=0.010)and sTWEAK(Z=1.537,P=0.124)alone.Conclusion Serum Hcy and sTWEAK can effectively diagnose AIS patients with WML and evaluate the severity of WML,and the high expressions of serum Hcy and sTWEAK are independent risk factors for AIS patients with WML.

关 键 词：急性缺血性脑卒中 前循环 脑白质病变 同型半胱氨酸 可溶性肿瘤坏死因子样弱凋亡诱导剂 血清 预测价值 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]