血清Lp-PLA2、pro-BNP、NSE及CRP水平与行急诊静脉溶栓治疗脑梗死患者预后关系

Relationship between Serum LP-PLA2,pro-BNP,NSE and CRP Levels and Prognosis of Patients with Acute Cerebral Infarction with Emergency Intravenous Thrombolysis

目的:探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)、B型钠尿肽前体(pro-BNP)、神经元特异性烯醇化酶(NSE)及C反应蛋白(CRP)水平与行急诊静脉溶栓治疗急性脑梗死(ACI)患者预后的关系。方法:选取2018年4月~2019年4月医院急诊收治入院的76例行急诊阿替普酶静脉溶栓治疗的ACI患者入组,根据预后情况分为预后良好组(n=42)和预后不良组(n=34)。比较不同预后患者溶栓前血清Lp-PLA2、pro-BNP、NSE及CRP水平,以及各指标间相关性,不同预后患者NIHSS评分,各指标与溶栓前NIHSS评分相关性。利用改良Rankin量表评估溶栓后90d预后,采用Logistic回归分析影响患者溶栓后90d预后的危险因素。采用ROC曲线分析血清Lp-PLA2、pro-BNP、NSE及CRP对患者预后的评估价值。结果:预后不良组患者溶栓前血清Lp-PLA2、pro-BNP、NSE及CRP水平高于预后良好组,差异具有统计学意义;血清Lp-PLA2、pro-BNP、NSE及CRP水平,两两均呈显著正相关关系;溶栓后24h、14d和90d两组患者美国国立卫生研究院卒中量表(NIHSS)评分低于溶栓前,差异具有统计学意义;预后不良组患者溶栓前、溶栓后24h、14d和90d的NIHSS评分高于预后良好组,差异具有统计学意义;血清Lp-PLA2、pro-BNP、NSE及CRP与溶栓前NIHSS评分均呈显著正相关关系;溶栓前Lp-PLA2、pro-BNP、NSE水平和NIHSS评分为影响患者溶栓后90d预后的独立危险因素;血清Lp-PLA2、pro-BNP、NSE及CRP评估患者预后价值较高。结论:溶栓前血清Lp-PLA2、pro-BNP、NSE及CRP水平与行急诊静脉溶栓治疗ACI患者病情和预后有关,有可能成为行急诊静脉溶栓治疗ACI患者预后预测指标。

Objective To investigate the relationship between serum lipoprotein-related phospholipase A2(Lp-PLA2),pro-B-type natriuretic peptide(pro-BNP),neuron-specific enolase(NSE)and C-reactive protein(CRP)levels and prognosis of patients with acute cerebral infarction(ACI)treated with emergency intravenous thrombolysis.Methods 76 ACI patients with emergency intravenous thrombolysis in our hospital from April 2018 to April 2019 were enrolled,and divided into two groups according to prognosis,good prognosis group(n=42)and poor prognosis group(n=34).Serum Lp-PLA2,pro-BNP,NSE and CRP levels,and National Institutes of Health Stroke Scale(NIHSS)score were compared between groups.The correlation between indexes and pre-thrombolysis NIHSS score was analyzed.The modified Rankin scale was used to evaluate the prognosis at post-thrombolysis 90 days,and Logistic regression was used to analyze the risk factors affecting the prognosis at post-thrombolysis 90 days.ROC curve was used to analyze the prognostic value of serum Lp-PLA2,pro-BNP,NSE and CRP.Results Serum levels of Lp-PLA2,pro-BNP,NSE and CRP before thrombolysis in poor prognosis group were higher than those in good prognosis group.Serum LP-PLA2,pro-BNP,NSE and CRP levels were significantly positively correlated.NIHSS scores were decreased in both groups at post-thrombolysis 24h,14d and 90d,and were lower in good prognosis group than in poor prognosis group.Serum LP-PLA2,pro-BNP,NSE and CRP were positively correlated with pre-thrombolysis NIHSS score.The LP-PLA2,pro-BNP,NSE levels and NIHSS score before thrombolysis were independent risk factors for prognosis at post-thrombolysis 90d.Serum Lp-PLA2,pro BNP,NSE and CRP have higher prognostic value.Conclusion Serum Lp-PLA2,pro-BNP,NSE,and CRP levels before thrombolysis are related to the condition and prognosis of ACI patients undergoing emergency intravenous thrombolysis,and may become prognostic indicators for ACI patients.