目的:探究血清二十碳五烯酸(eicosapentaenoic acid,EPA)/花生四烯酸(arachidonic acid,AA)比值联合可溶性肿瘤坏死因子样弱凋亡诱导剂(soluble tumor necrosis factor-like weak apoptosis inducer,sTWEAK)在合并脑白质疏松(leukoaraiosis,LA)的急性脑梗死患者溶栓后出血转化和预后评估中的临床价值.方法:选择2021年2月—2023年2月收治的149例急性脑梗死合并LA患者,均接受静脉溶栓治疗,根据其溶栓后出血转化情况分为非出血转化组与出血转化组,检测并比较两组血清EPA/AA比值、sTWEAK水平.分析血清EPA/AA比值联合sTWEAK预测急性脑梗死合并LA患者溶栓后出血转化的效能.随访3个月,采用改良Rankin量表(mRS)评估急性脑梗死合并LA患者的预后情况,根据预后将其分为预后良好组与预后不良组,比较两组临床资料、实验室指标及血清EPA/AA比值、sTWEAK水平.多因素回归分析急性脑梗死合并LA患者预后不良的影响因素;ROC曲线分析血清EPA/AA比值联合sTWEAK预测患者预后不良的价值.结果:与非出血转化组比较,出血转化组血清EPA、EPA/AA比值显著降低,sTWEAK显著升高,均差异有统计学意义(P＜0.05).当EPA/AA比值＜0.37、sTWEAK＞279.6 pg/mL时,两者联合预测急性脑梗死合并LA患者溶栓后出血转化的曲线下面积(area under the curve,AUC)、灵敏度、特异度依次为0.861、82.12％、90.14％,显著优于单项指标检测,差异有统计学意义(P＜0.05).多因素分析结果显示,年龄增大、sTWEAK升高、合并高血压、出血转化、溶栓24 h后NIHSS评分升高是急性脑梗死合并LA患者预后不良的危险因素(P＜0.05),而EPA、EPA/AA比值升高为其保护因素(P＜0.05).血清EPA/AA比值联合sTWEAK检测预测急性脑梗死合并LA患者预后不良的AUC、灵敏度、特异度依次为0.899、83.32％、98.11％,显著优于单项指标检测,差异有统计学意义(P＜0.05).结论:血清EPA/AA比值下降、sTWEAK水平升高与合并LA的急性脑梗死患者溶栓后出血转化和预后不良的发生有关,二者联合检测对于溶栓后出血转化及预后不良均有较高的预测价值.
Clinical study of serum EPA/AA ratio combined with sTWEAK in the evaluation of hemorrhagic transformation and prognosis after thrombolysis in patients with acute cerebral infarction with leukoaraiosis
Objective:To explore the clinical value of serum eicosapentaenoic acid(EPA)/arachidonic acid(AA)ratio combined with soluble tumor necrosis factor-like weak apoptosis inducer(sTWEAK)in assessing post thrombolytic hemorrhage transformation and prognosis in patients with acute cerebral infarction complicated with cerebral leukoaraiosis(LA).Methods:One hundred and forty nine patients with acute cerebral infarction with LA who were admitted from February 2021 to February 2023 were selected,and all patients treated with intravenous thrombolysis,the patients were divided into non-hemorrhagic transformation group and hemorrhagic transforma-tion group according to the hemorrhagic transformation after thrombolysis.Serum EP A/AA ratio and sTWEAK level were detected and compared between the two groups.The efficacy of serum EPA/AA ratio combined with sTWEAK in predicting hemorrhagic transformation after thrombolysis in patients with acute cerebral infarction complicated with LA were analyzed.After 3 months of follow-up,the prognosis of patients with acute cerebral in-farction with LA were evaluated by mRS,patients were divided into good prognosis group and poor prognosis group according to the prognosis,the clinical data,laboratory indexes,serum EPA/AA ratio and sTWEAK level were compared between two groups.The influencing factors of poor prognosis in patients with acute cerebral in-farction with LA were analyzed by multivariate regression.The value of serum EP A/AA ratio combined with sTWEAK in predicting poor prognosis of patients were analyzed by ROC curve.Results:Compared with the non-hemorrhagic transformation group,the hemorrhagic transformation group showed a significant decrease in serum EPA and EPA/AA ratio(P＜0.05),and a significant increase in sTWEAK(P＜0.05).When the EPA/AA ratio was less than 0.37 and sTWEAK was greater than 279.6 pg/mL,the combined prediction of the area under the curve(AUC),sensitivity,and specificity of thrombolytic transformation in patients with acute cerebral infarction complicated with LA were 0.861,82.12％,and 90.14％,which were respectively,significantly better than these of single indicator detection(P＜0.05).Multivariate analysis showed that,increased age,elevated sTWEAK,hy-pertension,hemorrhagic transformation and increased NIHSS score after 24 hours of thrombolysis were risk fac-tors for poor prognosis in patients with acute cerebral infarction with LA(P＜0.05),while elevated EPA and EPA/AA ratio were protective factors(P＜0.05).The AUC,sensitivity and specificity of serum EPA/AA ratio combined with sTWEAK detection in predicting poor prognosis of patients with acute cerebral infarction with LA were 0.899,83.32％and 98.11％respectively,which were significantly better than those of single index detec-tion(P＜0.05).Conclusion:The decrease of serum EPA/AA ratio and sTWEAK level are relate to the occurrence of hemorrhagic transformation and poor prognosis after thrombolysis in patients with acute cerebral infarction with LA,the combine detection has a high predictive value for hemorrhagic transformation and poor prognosis after thrombolysis.
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