血清Hcy、尿酸水平与急性缺血性脑卒中患者出血转化风险的关系  

Relationship between Serum Hcy and UA Levels and the Risk of Hemorrhage Transformation in Patients with Acute Ischemic Stroke

作　　者：袁梦 陈斐 杜扬煊 杨懿哲 王丹 牛雪燕 孟恺 YUAN Meng;CHEN Fei;DU Yangxuan;YANG Yizhe;WANG Dan;NIU Xueyan;MENG Kai(Department of General Practice,Zhabei Central Hospital of Jing'an District,Shanghai 200000,China)

机构地区：[1]上海市静安区闸北中心医院全科医学科,上海200000

出　　处：《临床误诊误治》2025年第9期66-70,76,共6页Clinical Misdiagnosis & Mistherapy

基　　金：上海市静安区学科建设项目(2021YL02)。

摘　　要：目的 探讨血清同型半胱氨酸(Hcy)、尿酸水平与急性缺血性脑卒中患者出血转化风险的相关性。方法 回顾性分析2021年5月至2024年6月收治的120例急性缺血性脑卒中患者的临床资料,根据是否存在出血转化分为出血转化组33例和非出血转化组87例。比较2组血清Hcy、尿酸水平及一般资料。采用受试者工作特征(ROC)曲线评估血清Hcy、尿酸对急性缺血性脑卒中患者出血转化风险的预测价值,采用多因素logistic回归分析急性缺血性脑卒中患者出血转化风险的影响因素。结果 出血转化组患者血清Hcy、尿酸水平均明显高于非出血转化组(P<0.01)。ROC曲线分析显示,血清Hcy、尿酸及Hcy联合尿酸预测急性缺血性脑卒中患者出血转化的曲线下面积(95%CI)分别为0.850(0.800,0.900)、0.866(0.816,0.916)、0.906(0.856,0.956)。多因素logistic回归分析显示,入院时美国国立卫生研究院脑卒中量表评分>16.22分、血清C反应蛋白>11.14 mg/L、Hcy>16.55μmol/L、尿酸>355.85μmol/L均为急性缺血性脑卒中患者出血转化的危险因素(P<0.01)。结论 血清Hcy、尿酸水平异常升高均是急性缺血性脑卒中患者出血转化的危险因素,可作为评估患者出血转化发生的有效指标,且二者联合具有更高的预测效能。Objective To investigate the correlation between serum homocysteine(Hcy) and uric acid levels and the risk of hemorrhagic transformation(HT) in patients with acute ischemic stroke(AIS).Methods The clinical data of 120 patients with AIS admitted to our hospital from May 2021 to June 2024 were retrospectively analyzed.According to the presence or absence of hemorrhagic transformation,the patients were divided into hemorrhagic transformation group(n=33) and non-hemorrhagic transformation group(n=87).Serum Hcy,uric acid levels and other general data were compared between the two groups.The receiver operating characteristic(ROC) curve was used to evaluate the predictive value of serum Hcy and uric acid for the risk of hemorrhagic transformation in patients with AIS.Multivariate logistic regression was used to analyze the influencing factors of hemorrhagic transformation risk in patients with AIS.Results The levels of serum Hcy and uric acid in the hemorrhagic transformation group were significantly higher than those in the non-hemorrhagic transformation group(P<0.01).ROC curve analysis showed that the area under the curve(95%CI) of serum Hcy and uric acid alone and in combination for predicting hemorrhagic transformation in patients with AIS was 0.850(0.800,0.900),0.866(0.816,0.916),0.906(0.856,0.956),respectively.Multivariate logistic regression analysis showed that,the National Institutes of Health Stroke Scale score >16.22,serum C reactive protein >11.14 mg/L,Hcy >16.55 μmol/L,and uric acid >355.85 μmol/L at admission were all risk factors for hemorrhagic transformation in patients with AIS(P<0.01).Conclusion Abnormal increase of serum Hcy and uric acid levels are both risk factors for hemorrhagic transformation in patients with AIS,which can be used as effective indicators to evaluate the occurrence of hemorrhagic transformation in patients,and the combination of the two has higher predictive efficiency.

关 键 词：急性缺血性脑卒中 出血转化 同型半胱氨酸 尿酸 美国国立卫生研究院脑卒中量表 C反应蛋白 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]