Association of Serum PTX3 Level with First-pass Effect and Prognosis of Mechanical Thrombectomy in Patients with Acute Ischemic Stroke of Large Vessel Occlusion
Association of Serum PTX3 Level with First-pass Effect and Prognosis of Mechanical Thrombectomy in Patients with Acute Ischemic Stroke of Large Vessel Occlusion
郝瑜 1刘超 2曹银光 1李长云1
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作者信息
1. 聊城市人民医院检验科,山东聊城 252000
2. 聊城市人民医院神经外科,山东聊城 252000
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摘要
目的 探讨正五聚蛋白3(pentraxin 3,PTX3)与大血管闭塞型急性缺血性脑卒中(acute ischemic stroke,AIS)患者机械取栓首次通过效应的关系.方法 选取2023年1～8月在聊城市人民医院进行治疗的大血管闭塞型AIS患者136例,进行机械取栓根据是否获得首次通过效应将其分为首次通过组(n=41)以及未首次通过组(n=95).收集所有患者的临床资料并检测血清PTX3的水平.对所有患者进行三个月的随访,根据改良Rankin评分判定预后情况.采用多因素Logistic回归法分析大血管闭塞型AIS患者首次通过效应的影响因素,采用受试者工作特征(ROC)曲线分析血清PTX3对大血管闭塞型AIS患者首次通过效应的预测价值.结果 首次通过组的预后情况良好率高于未首次通过组(56.10％vs 36.84％),差异具有统计学意义(x2=4.341,P=0.037).与未首次通过组相比,首次通过组的年龄(59.38±5.12岁)、高血压比例(43.90％)、入院美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分(13.58±4.16 分)以及血清 PTX3 水平(1.21±0.32 ng/L)均低于未首次通过组(63.45±7.61 岁,65.26％,15.75±5.13 分,1.71±0.41 ng/L),差异具有统计学意义(t/x2=3.129,5.395,2.389,6.944,均P＜0.05).经多因素Logistic回归法分析显示,年龄较小[OR(95％CI):0.859(0.752～0.982)]、无高血压[OR(95％CI):0.672(0.480～0.942)]、入院 NIHSS 评分下降[OR(95％CI):0.867(0.781～0.962)]以及血清PTX3水平下降[OR(95％CI):0.558(0.326～0.954)]均是大血管闭塞型AIS患者机械取栓首次通过效应的影响因素(Waldx2值=4.997,5.238,7.280,4.543,均P＜0.05).经过三个月随访,预后良好组的血清PTX3水平低于预后不良组(1.28±0.39 ng/L vs 1.65±0.43 ng/L),差异具有统计学意义(t=5.111,P＜0.001).经ROC分析显示,血清PTX3对大血管闭塞型AIS患者首次通过效应和不良预后的预测价值较高,曲线下面积(95％CI)分别为0.785(0.703～0.866)和0.734(0.651～0.806),最佳临界值分别为1.38 ng/L和1.56 ng/L.结论 大血管闭塞型AIS患者机械取栓获得首次通过效应利于短期预后,血清PTX3的表达情况与大血管闭塞型AIS患者首次通过效应密切相关,且该指标对患者能否获得首次通过效应有较高的预测价值.
Abstract
Objective To investigate the relationship between pentraxin 3(PTX3)and first-pass effect of mechanical thrombectomy in patients with large vessel occlusion acute ischemic stroke(AIS).Methods A total of 136 AIS patients with large vessel occlusion treated in Liaocheng People's Hospital from January to August 2023 were selected,and they were divided into first pass group(n=41)and non-first pass group(n=95)according to whether they achieved first-pass effect of mechanical thrombectomy.The clinical data of all patients were collected and the serum PTX3 levels were detected.All patients were followed up for 3 months,and the prognosis was evaluated according to the modified Rankin score.Multivariate Logistic regression was used to analyze the influencing factors of first-pass effect in AIS patients with large vessel occlusion.ROC analysis was used to analyze the predictive value of serum PTX3 for first-pass effect in AIS patients with large vessel occlusion.Results The rate of good prognosis in the first pass group was higher than that in the non-first pass group(56.10％vs 36.84％),and the difference was significant(x2=4.341,P=0.037).Compared with the non-first pass group,the age(59.38±5.12 years),the proportion of hypertension(43.90％),the National Institutes of Health Stroke Scale(NIHSS)score at admission(13.58±4.16 score)in the first pass group and serum PTX3 level(1.21±0.32 ng/L)in the first pass group were lower than those in the failed group(63.45±7.61 years,65.26％,15.75±5.13 score,1.71±0.41 ng/L),and the differences were significant(t/x2=3.129,5.395,2.389,6.944,all P＜0.05).Multivariate Logistic regression analysis showed that younger age[OR(95％CI):0.859(0.752～0.982)],no hypertension[OR(95％CI):0.672(0.480～0.942)],decreased NIHSS score at admission[OR(95％CI):0.867(0.781～0.962)]and decreased serum PTX3 levels[OR(95％CI):0.558(0.326～0.954)]were the influencing factors of the first-pass effect of mechanical thrombectomy in AIS patients with large vessel occlusion(Waldx2=4.997,5.238,7.280,4.543,all P＜0.05).After 3 months of follow-up,the serum PTX3 level of the good prognosis group was lower than that of the poor prognosis group(1.28±0.39 ng/L vs 1.65±0.43 ng/L),and the difference was significant(t=5.111,P＜0.001).ROC analysis showed that serum PTX3 had a high predictive value for first-pass effect and poor prognosis in AIS patients with large vessel occlusion,with the areas under the curve(95％CI)of 0.785(0.703～0.866)and 0.734(0.651～0.806),respectively,and their optimal cut-off values were 1.38 ng/L and 1.56 ng/L,respectively.Conclusion The first-pass effect of mechanical thrombectomy in AIS patients with large vessel occlusion is beneficial to the short-term prognosis.The expression of serum PTX3 is closely related to the first-pass effect in AIS patients with large vessel occlusion,and this index could have a high predictive value for whether the patients can achieve the first-pass effect.
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