摘要
目的探究联合CT检测分析血浆脂蛋白相关磷脂酶(Lp-PLA 2)、抵抗素、脂联素及血小板源性生长因子(PDGF)、血管内皮细胞生长因子(VEGF)对于急性缺血性脑卒中(AIS)患者溶栓后出血转化(HT)的预测价值。方法选取2021年4月~2023年4月衡水市第二人民医院就诊并进行静脉深检治疗的200例AIS患者,按照接受溶栓治疗后2 h内是否发生HT,将其划分为对照组(未出血,n=170)和观察组(出血,n=30)。于溶栓治疗前采集AIS患者外周血,离心取血浆,使用酶联免疫吸附实验(ELISA)法检测Lp-PLA 2、抵抗素、脂联素、PDGF及VEGF水平等水平;通过D-CTA测定侧支循环评分及血栓负荷(CBS)评分;logistic回归分析AIS患者溶栓治疗后HT的影响因子;ROC分析曲线评估血浆Lp-PLA 2、抵抗素、脂联素、PDGF及VEGF对AIS患者溶栓后发生HT的预测价值。结果与对照组相比,观察组患者血浆Lp-PLA 2、抵抗素、PDGF及VEGF明显升高[(287.37±39.10)μg/L vs.(234.23±27.16)μg L、(22.73±4.24)μg/L vs.(14.96±3.41)μg L、(598.85±42.52)μg/L vs.(491.51±34.99)μg L、(253.39±63.41)μg/L vs.(182.47±32.26)μg L],脂联素浓度明显降低[(13.46±2.81)mg/L vs.(18.93±4.37)mg L],差异有统计学意义(t=-6.749、-8.123、15.11、6.736、4.829,P<0.05)。血浆Lp-PLA 2、抵抗素等指标是AIS患者溶栓治疗后出现HT的危险因素(P<0.05),而脂联素与D-CTA侧支循环评分为保护因素(P<005)。以血浆Lp-PLA 2浓度、血浆抵抗素浓度、血浆脂联素浓度、PDGF浓度、VEGF、D-CTA及CBS曲线下面积(AUC)分别为0.865、0.919、0.850、0.831、0.788、0.732及0.878;敏感度分别为81.3%、81.3%、87.5%、81.3%、86.3%、78.9%及83.2%,特异度分别为88.3%、86.2%、777%、85.3%、79.3%、81.4%及78.4%,约登指数分别为0.696、0.675、0.652、0.665、0.653、0.603及0.616。结论D-CTA侧支循环评分及CBS评分联合血浆Lp-PLA 2、抵抗素等增高是导致AIS溶栓后HT出现的危险因素。同时,体内脂联素浓度升高说明其为保护因素。以上因素对于溶栓治疗后HT是否发生均有着一定的预测效果,以联合预测价值最高。
Objective To investigate the predictive value of combined CT assay analysis of plasma lipoprotein-related phospholipase Lp-PLA 2,resistin,lipocalin and PDGF and VEGF on post-thrombolytic hemorrhagic transformation(HT)in patients with acute ischemic stroke(AIS).Methods Two hundred patients with AIS who attended our hospital from April 2021 to April 2023 and underwent deep venous examination were divided into a control group(170 patients)and a test group(30 patients)according to whether HT occurred within 2 hours after receiving thrombolytic therapy.Peripheral blood was collected from AIS patients before thrombolytic treatment,and plasma was centrifuged to detect Lp-PLA 2 and other levels using enzyme-linked immunosorbent assay(ELISA).Lateral circulation score and CBS score were measured by D-CTA.Logistic regression analysis was performed to determine the factors affecting HT after thrombolytic treatment in AIS patients.ROC analysis curves were used to assess the effect of plasma Lp-PLA 2,resistin and other factors on HT after thrombolytic treatment.The predictive value of plasma Lp-PLA 2 and resistin on the occurrence of HT after thrombolysis in AIS patients was assessed by ROC analysis curve.Results Compared with the control group,plasma Lp-PLA 2 and resistin were significantly higher,and lipocalin concentration was significantly lower in the test group(t=-6.749,-8.123,15.11,6.736,4.829,P<0.05).Increased plasma Lp-PLA 2 and resistin were risk factors for HT after thrombolytic therapy in AIS patients(P<0.05),but lipocalin and D-CTA collateral circulation score were protective factors(P<0.05).The AUCs for plasma Lp-PLA 2 concentration,plasma resistin concentration,plasma lipocalin concentration,PDGF concentration,VEGF,D-CTA and CBS were 0.865,0.919,0.850,0.831,0.788,0.732 and 0.878,respectively.The sensitivities were 81.3%,81.3%,87.5%,81.3%,86.3%,78.9%and 83.2%,respectively,with specificities of 88.3%,86.2%,777%,85.3%,79.3%,81.4%and 78.4%,respectively,and Jordans of 0.696,0.675,0.652,0.665,0.653,0.603 and 0.616,respectively.Conclusion Increased D-CTA collateral circulation score and CBS score combined with increased plasma Lp-PLA 2 and resistin are risk factors for the development of HT after thrombolysis in AIS.At the same time,elevated concentrations of lipocalin in vivo indicate that it is a protective factor.All of these factors have a predictive effect on the occurrence of HT after thrombolytic therapy,with the combination having the highest predictive value.
作者
李士威
张冰
李彩艳
王晓
Li Shiwei;Zhang Bing;Li Caiyan(Department of Functional,the Second People′s Hospital of Hengshui,Hengshui 053000,China)
出处
《中华保健医学杂志》
2023年第6期625-629,共5页
Chinese Journal of Health Care and Medicine
基金
衡水市科技计划项目(2022014063Z)。
关键词
急性缺血性脑卒中
出血转化
CT
多因素联合
预测价值
Acute ischaemic stroke
Haemorrhagic transformation
CT
Multifactorial combination
Predictive value
