血浆胱抑素C对急性缺血性卒中患者静脉溶栓治疗转归的影响

Effect of plasma cystatin C on outcome of intravenous thrombolysis in patients with acute ischemic stroke

目的探讨血浆胱抑素C（cystatin C，CysC）浓度对急性缺血性卒中患者静脉溶栓治疗转归的影响。方法回顾性纳入连续的急性缺血性卒中静脉溶栓患者，根据改良Rankin量表评分分为转归良好组（mRS评分≤2分）和转归不良组（mRS评分〉2分），根据是否存在出血性转化（hemorrhagic transformation，HT）分为HT组和非HT组，对人口统计学和临床资料进行比较。结果共纳入接受静脉溶栓治疗的急性缺血性卒中患者103例，转归良好组44例，转归不良组59例；TH组23例，非HT组80例。转归良好组年龄[（62．34±13．41）岁对（68．09±9．74）岁；t=2．521，P=0．013]、基线CysC浓度[（1．008±0．28）mg／L对（1．27±0．86）mg／L；t=2．237，P=0．027]、HT发生率（14％对34．9％；χ^2=6．016，P=0．014）以及美国国立卫生研究院卒中量表（National Institutes of Heakh Stroke Scale，NIHSS）评分[（10．39±3．11）分对（18±2．65）分；t=13．35，P〈0．001]显著低于转归不良组。多变量logistic回归分析显示，CysC与转归之间无显著独立相关性（优势比1．783，95％可信区间0．443～7．185；P=0．416）。非HT组基线CysC浓度[（1．41±0．54）mg／L对（0．96±0．18）mg／L；t=3．941，P=0．001]和NIHSS评分[（15．96±3．7）分对（13．05±4．87）分；t=3．017，P=0．004]显著低于HT组。多变量logistic回归分析显示，血浆CysC浓度〉1．03mg／L（优势比9．050，95％可信区间2．384～34．359；P=0．001）是HT的独立危险因素。结论基线血浆CysC浓度增高与急性缺血性卒中患者静脉溶栓治疗后发生HT有关，但与转归无关。

Objective To investigate the effect of cystatin C （CysC） concentration on outcome of intravenous thrombolysis in patients with acute ischemic stroke. Methods The consecutive patients with acute ischemic stroke who underwent intravenous thrombolysis were enrolled retrospectively. They were divided into a good outcome group （≤2） and a poor outcome group （〉2） according to the Rankin scale. They were also divided into a hemorrhagic transformation （HT） group and a non-HT group according to whether they had HT or not. Their demographic data and clinical data were compared. Results A total of 103 patients with acute ischemic stroke treated with intravenous thrombolysis were enrolled, 44 in the good outcome group, 59 in the poor outcome group; 23 in the TH group, and 80 in the non-HT group. The age （62.34 ± 13.41 years vs. 68.09± 9.74 years; t = 2. 521, P = 0. 013）, baseline CysC concentration （1. 008 ±0. 28 mg/L vs. 1. 27± 0.86 mg/L; t = 2. 237, P = 0. 027）, incidence of HT （14% vs, 34, 9% ; χ^2 =6. 016, P = 0. 014） and National Institutes of Health Stroke Scale （NIHSS） score （10. 39 ±3.11 vs. 18 ±2.65; t = 13.35, P 〈 0.001 ） in the good outcome group were significantly lower than those in the poor outcome group. Multivariate logistic regression analysis showed that there was no significant independent correlation between CysC and clinical outcome （odds ratio 1. 783,95% confidence interval 0. 443 - 7. 185 ; P =0. 416）. The baseline CysC concentration （1.41 ±0. 54 mg/L vs. 0. 96 ±0. 18 mg/L; t = 3. 941, P =0. 001） and the NIHSS score （15.96 ±3.7 vs. 13.05 ±4. 87; t =3. 017, P =0. 004） in the non-HT group were significantly lower than those in the HT group. Multivariate logistic regression analysis showed that the plasma CysC concentration 〉 1.03 mg/L （odds ratio 9. 050, 95% confidence interval 2. 384 -34. 359; P = 0.001） was an independent risk factor for HT. Conclusions The increased baseline plasma CysC concentration was associated with the occurrence of HT in patients with acute ischemic stroke after intravenous thrombolysis therapy, but it was not associated with the outcomes.