血清和肽素水平与急性缺血性卒中患者转归的相关性

Correlation between plasma copeptin levels and outcomes in patients with acute ischemic stroke

目的探讨血清和肽素水平与急性缺血性卒中患者转归的关系。方法纳入发病24h内的首次缺血性卒中患者，应用酶联免疫吸附法检测血清和肽素水平，应用美国国立卫生研究院卒中量表（NationalInstitutesofHealthStrokeScale，NIHSS）评估基线卒中严重程度。在发病后90d时应用改良Rankin量表（modifiedRankinscale，mRS）评分评价转归，0～2分定义为转归良好。年龄和性别相匹配的健康体检者作为对照者。结果共纳入连续86例发病24h内首次缺血性卒中患者和50名年龄和性别相匹配的健康体检者作为对照者。急性缺血性卒中患者发病24h、7d和14d血清和肽素水平分别为（7．81±0．66）pmol／L、（4．78±1．76）pmol／L和（2．82±1．42）pmol／L，均显著高于对照组[（1．67±0．56）pmokL；P均〈0．05]。86例患者中，74例（86．05％）转归良好，12例（13．95％）转归不良。转归不良组年龄[（67．64±9．62）岁对（61．12±7．31）岁；t=-3．420，P=0．020]、NIHSS评分[（14．16±4．22）分对（6．96±2．04）分；t=-8．263，P〈0．001]、基线收缩压[（166．06±13．42）mmHg对（154．12±11．69）mmHg；t=5．216，P=0．037；1mmHg=0．133kPa]、空腹血糖[（8．79±2．98）mmol／L对（6．92±2．24）mmol／L；t=2．076，P=0．041]、C反应蛋白[（7．02±1．72）mg/L对（4．07±1．58）meCL；t=-1．724，P=0．019]、24h时和肽素水平[（9．67±2．28）pmol／L对（6．88±2．82）pmol／L；t=13．962，P〈0．001]、7d时和肽素水平[（8．22±2．14）pmol／L对（2．97±2．04）pmol／L；t=20．564，P〈0．001]、14d时和肽素水平[（4．77±1．86）pmol／L对（2．02±0．76）pmol／L；t=8．428，P=0．032]以及心房颤动（33．33％对8．11％；x2=4．986，P=0．036）、大动脉粥样硬化性卒中（41．67％对21．62％；z。=6．729，P=0．038）、心源性栓塞（33．33％对8．11％ x2=4．986，P=0．036）的患者构成比均显著高于转归良好组，小动脉闭塞性卒中的患者构成比显著低于转归良好组（16．67％对70．27％弗=16．972，P=0．041）。多变量logistic回归分析显示，血清24h（优势比2．424，95％可信区间1．920～3．562；P〈0．001）和7d（优势比2．326，95％可信区间1．768～3．482；P〈0．001）时和肽素水平以及基线NIHSS评分（优势比2．146，95％可信区间1．616～3．268；P〈0．001）是转归不良的独立危险因素。结论基线血清和肽素水平增高是急性缺血性卒中患者90d时转归不良的独立预测因素。

Objective To investigate the relationship between the serum copeptin levels and the outcomes in patients with acute ischemic stroke. Methods Patients with first-ever ischemic stroke within 24 h were enrolled in the study. Enzyme-linked immunosorbent assay was used to detect the serum copeptin levels. The National Institutes of Health Stroke Scale （NIHSS） was used to evaluate the severity of baseline stroke. The modified Rankin Scale （mRS） scores were used to evaluate the outcomes at d^ty 90, and 0-2 was defined as good outcome. The age- and sex-matched healthy subjects were used as controls. Results A total of 86 consecutive patients with first-ever ischemic stroke within 24 h were enrolled and 50 age-and sex-matched healthy subjects were used as controls. The serum copeptin levels of the patients with acute ischemic stroke at 24 h, day 7 and 14 were 7. 81 ± 0. 66 pmol/L, 4. 78 ± 1.76 pmol/L, and 2.82 ±1.42 pmol/L, respectively. They were all significantly higher than those of the control group （1.67 ± 0. 56 pmol/L; all P〈0. 05）. In 86 patients, 74 （86. 05%） had good outcome and 12 （13.95%） had poor outcome. The age （67. 64 ± 9. 62 years vs. 61.12 ± 7. 31 years; t = -3. 420, P = 0. 020）, NIHSS score （14. 16 ±4. 22 vs. 6. 96 ± 2. 04; t = - 8. 263, P 〈 0. 001 ）, baseline systolic blood pressure （166. 06 ± 13.42 mmHg vs. 154. 12± 11.69 mmHg; t = 5. 216, P = 0. 037; 1 mmHg= 0. 133 kPa）, fasting blood glucose （8.79 ±2. 98 mmol/L vs. 6. 92 ±2.24 mmol/L; t =2. 076, P =0. 041）, C-reactive protein （7. 02 ± 1.72 mg/L vs. 4. 07 ± 1.58 mg/L; t = - 1. 724, P =0. 019）, copeptin level at 24 h （9. 67 ±2.28 pmol/L vs. 6.88±2.82 pmol/L; t= 13.962, P〈0.001）, copeptin level at day 7 （8.22±2. 14 pmol/L vs. 2.97± 2. 04 pmol/L; t = 20. 564, P 〈 0. 001 ）, copeptin level at day 14 （4. 77 ± 1.86 pmol/L vs. 2.02 ± 0. 76 pmol/L; t =8. 428, P = 0. 032）, as well as the proportions of atrial fibrillation （33. 33% vs. 8. 11% ; X2 =4. 986, P =0. 036）, large artery atherosclerotic stroke （41.67% vs. 21.62% ;X2 =6. 729, P =0. 038）, cardioembolism （33.33% vs. 8. 11% ;X2 =4. 986, P =0. 036） in the poor outcome group were significantly higher than those in the good outcome group. The proportion of patients with small arterial occlusive stroke was significantly lower than that of the good outcome group （16. 67% vs. 70. 27% ; X2 = 16. 9;/2, P = 0. 041）. Multivariate logistic regression analysis showed that the serum copeptin level at 24 h （odds ratio 2.424, 95% confidence interval 1.92 0-3. 562; P 〈 0. 001） and day 7 （odds ratio 2. 326, 95% confidence interval 1. 768-3. 482; P 〈 0. 001）, and baseline NIHSS score （odds ratio 2. 146, 95% confidence interval 1. 616-3.268; P 〈 0. 001 ） were the independent risk factors for the pgor outcomes. Conclusions The increased baseline serum copeptin level is an independent risk factor for poor outcomes at day 90 in patients with acute ischemic stroke.