急性缺血性脑卒中静脉溶栓患者血清血管生成素2和应激诱导蛋白2的水平观测及其与临床预后的相关性  

Observation of serum angiopoietin-2 and stress-induced protein 2 levels in patients with acute ischemic stroke after intravenous thrombolysis and their correlation with clinical prognosis

作　　者：易伟 王凡 罗杰峰 Yi Wei;Wang Fan;Luo Jiefeng(Clinical Medical School,Guizhou Medical University,Guiyang 550081,China;Department of Neurosurgery,Baiyun Hospital Affiliated to Guizhou Medical University,Guiyang 550014,China)

机构地区：[1]贵州医科大学临床医学院,贵阳550081 [2]贵州医科大学附属白云医院神经外科,贵阳550014

出　　处：《中国医药》2025年第5期683-687,共5页China Medicine

基　　金：贵州省卫生健康委科学技术基金项目(gzwkj2022-253)。

摘　　要：目的探讨急性缺血性脑卒中(AIS)静脉溶栓患者血清血管生成素2(Ang-2)和应激诱导蛋白2(Sesn2)的水平变化及其与临床预后的相关性。方法前瞻性选取贵州医科大学附属白云医院2022年8月至2024年3月接受静脉溶栓治疗的105例AIS患者。于入院时检测血清Ang-2、Sesn2水平,并于溶栓后3个月评估患者预后情况。比较不同病情程度及不同预后患者血清Ang-2、Sesn2水平,分析血清Ang-2、Sesn2水平与AIS患者临床预后的关系并探讨对患者临床预后的预测价值。结果重度组(30例)血清Ang-2、Sesn2高于中重度组(46例)、中度组(29例)[(32±6)ng/L比(29±5)、(24±5)ng/L,(16±3)μg/L比(12±4)、(10±3)μg/L],且中重度组均高于中度组(均P<0.05)。溶栓后3个月,105例患者中45例预后不良。预后不良组血清Ang-2、Sesn2、D-二聚体水平及病情程度为重度的患者占比高于预后良好组(均P<0.05)。多因素Logistic回归分析结果显示,病情程度为重度、D-二聚体、Ang-2、Sesn2水平均为临床预后的影响因素(均P<0.05);限制性立方样条模型分析显示,AIS患者临床预后与血清Ang-2、Sesn2水平的关联均呈非线性曲线型剂量反应关系(均P<0.05),血清Ang-2、Sesn2对AIS患者临床预后存在正向交互作用(截断值分别为28.18 ng/L、12.61μg/L);绘制列线图,AIS患者血清Ang-2、Sesn2水平辅助病情程度、D-二聚体水平预测临床预后风险模型的一致性指数为0.975(95%置信区间:0.951~0.999),区分度良好;绘制决策曲线,血清Ang-2、Sesn2辅助病情程度、D-二聚体水平绘制的决策曲线净收益率更高,最大净收益率为0.429。结论AIS患者病情越严重血清Ang-2、Sesn2水平越高,当治疗前血清Ang-2、Sesn2水平分别>28.18 ng/L、12.61μg/L时,可能提示临床预后不良高风险,血清Ang-2、Sesn2水平与病情程度、D-二聚体水平联合可提高对AIS患者临床预后的预测价值。Objective To observe serum angiopoietin-2(Ang-2) and stress-induced protein 2(Sesn2) levels in patients with acute ischemic stroke(AIS) after intravenous thrombolysis and their correlation with clinical prognosis.Methods A total of 105 AIS patients who received intravenous thrombolytic therapy in Baiyun Hospital Affiliated to Guizhou Medical University from August 2022 to March 2024 were prospectively selected.Serum Ang-2 and Sesn2 levels were measured at admission,and the prognosis was evaluated 3 months after thrombolysis.The levels of serum Ang-2 and Sesn2 in patients with different severity and prognosis were compared,and the relationship between serum Ang-2 and Sesn2 and the clinical prognosis of AIS patients was analyzed.Results The serum Ang-2 and Sesn2 in the severe group(30 cases) were higher than those in the moderate-severe group(46 cases) and the moderate group(29 cases)[(32±6)ng/L vs(29±5),(24±5)ng/L,(16±3)μg/L vs(12±4),(10±3)μg/L],and the moderate-severe group were higher than the moderate group(all P<0.05).At 3 months after thrombolysis,45 of 105 patients had poor prognosis.The levels of serum Ang-2,Sesn2 and D-dimer and the proportion of patients with severe disease severity in the poor prognosis group were higher than those in the good prognosis group(all P<0.05).Multivariate Logistic regression analysis showed that severe disease,D-dimer,Ang-2 and Sesn2 were independent prognostic factors(all P<0.05).The restricted cubic spline analysis showed that the serum Ang-2 and Sesn2 levels were positively correlated with the prognosis of AIS patients in a non-linear dose-response relationship(both P<0.05),and there was a positive interaction between serum Ang-2 and Sesn2 on the prognosis of AIS patients(the cut-off values were 28.18 ng/L and 12.61 μg/L,respectively).The nomogram showed that the concordance index of the model with serum Ang-2,Sesn2,D-dimer and disease severity was 0.975(95% confidence interval:0.951-0.999),and the discrimination was good.When the decision curve was drawn,the net

关 键 词：急性缺血性脑卒中 血管生成素2 应激诱导蛋白2 临床预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]