摘要
目的 观察急性脑梗死患者全身免疫炎症指数(SII)及血清淀粉样蛋白A(SAA)、N末端脑钠肽前体(NT-proBNP)水平,探讨其对急性脑梗死患者溶栓治疗后预后的预测价值.方法 2021年6月—2023年6月新疆维吾尔自治区人民医院诊治急性脑梗死患者122例,均行急诊静脉溶栓治疗,根据溶栓治疗后6个月内预后情况分为预后不良组41例和预后良好组81例.比较2组基础疾病、发病至溶栓治疗时间、溶栓治疗前SII及SAA、NT-proBNP、同型半胱氨酸(Hcy)、C反应蛋白(CRP)水平等.采用Spearman相关法分析急性脑梗死患者溶栓治疗后预后不良与糖尿病、发病至溶栓治疗时间、SII及SAA、NT-proBNP、Hcy、CRP水平的相关性;采用多因素logistic回归分析急性脑梗死患者溶栓治疗后预后不良的影响因素;绘制ROC曲线,评估SII、SAA、NT-proBNP单独及联合预测急性脑梗死患者溶栓治疗后预后不良的效能.结果 预后不良组糖尿病比率(21.95％)、发病至溶栓治疗时间≥4.5 h比率(39.02％)及SII(945.18±192.15)、SAA[(84.32±17.37)mg/L]、NT-proBNP[(679.57±125.14)ng/L]、Hcy[(15.87±3.51)μmol/L]、CRP[(34.58±6.72)mg/L]水平均高于预后良好组[7.41％、18.52％、713.04±119.01、(67.67±11.82)mg/L、(483.35±153.62)ng/L、(14.23±2.56)μmol/L、(32.23±4.60)mg/L](x2=5.340、6.039,t=8.212、6.238、7.073、2.939、2.274;P均＜0.05).急性脑梗死患者溶栓治疗后预后不良与糖尿病、发病至溶栓治疗时间、SII及SAA、NT-proBNP、Hcy、CRP 水平均呈正相关(rs=0.209,P=0.021;rs=0.222,P-0.014;rs=0.559,P＜0.001;rs=0.456,P＜0.001;rs=0.566,P＜0.001;rs=0.243,P=0.007;rs=0.224,P=0.013).SII(OR=1.012,95％CI:1.005～1.018,P＜0.001)、SAA(OR=1.126,95％CI:1.060～1.196,P＜0.001)、NT-proBNP(OR=1.007,95％CI:1.002～1.0i1,P=0.005)是急性脑梗死患者溶栓治疗后预后不良的影响因素.SII、SA A、NT-proBNP分别以880.53、79.21 mg/L、607.32 ng/L为最佳截断值,单独及联合预测急性脑梗死患者溶栓治疗后预后不良的AUC分别为0.841(95％CI:0.759～0.924,P＜0.001)、0.779(95％CI:0.689～0.869,P＜0.001)、0.846(95％CI:0.773～0.918,P＜0.001)、0.957(95％CI:0.922～0.992,P＜0.001),灵敏度分别为 63.41％、60.98％、78.05％、82.34％,特异度分别为 95.06％、83.95％、85.19％、95.63％;SII、SA A、NT-proBNP 联合预测的 AUC 均大于各指标单独预测(Z=4.021,P＜0.001;Z=3.331,P＜0.001;Z=3.320,P＜0.001).结论 急性脑梗死患者溶栓治疗前SII及SA A、NT-proBNP水平升高与溶栓治疗后短期预后不良相关,SII及SAA、NT-proBNP联合预测患者预后有较高价值.
Abstract
Objective To observe the levels of systemic immune-inflammation index(SII),serum amyloid A(SAA),and N-terminal pro-brain natriuretic peptide(NT-proBNP)of patients with acute cerebral infarction,and to explore their values to the prediction of prognosis after thrombolytic therapy.Methods A total of 122 patients with acute cerebral infarction received emergency intravenous thrombolytic therapy in People's Hospital of Xinjiang Uygur Autonomous Region from June 2021 to June 2023,and were categorized into good prognosis group(n=81)and poor prognosis group(n=41)based on the outcome 6 months after thrombolytic therapy.The clinical data as underlying diseases,time from onset to thrombolytic therapy,SII,and levels of SAA,NT-proBNP,homocysteine(Hcy)and C-reactive protein(CRP)before thrombolytic therapy were compared between two groups.Spearman's correlation coefficient was used to analyze the correlations of poor prognosis with diabetes,time from onset to thrombolytic therapy,SII,and levels of SAA,NT-proBNP,Hey and CRP.Multivariate logistic regression analysis was done to assess the influencing factors of poor prognosis of patients with acute cerebral infarction after thrombolytic therapy.ROC curves were plotted to evaluate the efficiencies of single and combined detection of SII,SAA and NT-proBNP on predicting poor prognosis of patients with acute cerebral infarction.Results The proportions of diabetes and time from onset to thrombolytic therapy ≥4.5 h,SII,and levels of SAA,NT-proBNP,Hcy and CRP were higher in poor prognosis group[21.95％,39.02％,945.18±192.15,(84.32±17.37)mg/L,(679.57±125.14)ng/L,(15.87±3.51)μmol/L,(34.58±6.72)mg/L]than those in good prognosis group[7.41％,18.52％,713.04±119.01,(67.67±11.82)mg/L,(483.35±153.62)ng/L,(14.23±2.56)μmol/L,(32.23±4.60)mg/L](x2=5.340,x2=6.039,t=8.212,t=6.238,t=7.073,t=2.939,t=2.274;all P values＜0.05).The poor prognosis after thrombolytic therapy was positively correlated with diabetes,time from onset to thrombolytic therapy,SII,and levels of SAA,NT-proBNP,Hcy and CRP in patients with acute cerebral infarction(rs=0.209,P=0.021;rs=0.222,P=0.014;rs=0.559,P＜0.001;r,=0.456,P＜0.001;rs=0.566,P＜0.001;rs=0.243,P=0.007;rs=0.224,P=0.013).SII(OR=1.012,95％CI:1.005-1.018,P＜0.001),SAA(OR=1.126,95％CI:1.060-1.196,P＜0.001)and NT-proBNP(OR=1.007,95％CI:1.002-1.011,P=0.005)were the influencing factors of poor prognosis after thrombolytic therapy in patients with acute cerebral infarction.When using 880.53,79.21 mg/L and 607.32 ng/L as the optimal cut-off values of SII,SAA and NT-proBNP,the AUCs of them three alone and in combination for predicting poor prognosis after thrombolytic therapy in patients with acute cerebral infarction were 0.841(95％CI:0.759-0.924,P＜0.001),0.779(95％CI:0.689-0.869,P＜0.001),0.846(95％CI:0.773-0.918,P＜0.001)and0.957(95％CI:0.922-0.992,P＜0.001),with the sensitivities of 63.41％,60.98％,78.05％and 82.34％,and the specificities of 95.06％,83.95％,85.19％and 95.63％,respectively.The AUC of combined detection was greater than that of any single one(Z=4.021,P＜0.001;Z=3.331,P＜0.001;Z=3.320,P＜0.001).Conclusion The elevated SII and levels of SAA and NT-proBNP before thrombolytic therapy are involved in poor prognosis of patients with acute cerebral infarction after thrombolytic therapy,and the combination of SII,SAA and NT-proBNP achieves a high predictive value.
基金项目
新疆维吾尔自治区自然科学基金(2022D01C128)
NETL
NSTL
万方数据