血清HbA1c、Hcy、UA水平对老年急性脑梗死患者预后的预测价值

The predictive value of serum HbA1c,Hcy and UA levels for the prognosis of elderly patients with acute cerebral infarction

目的探讨老年急性脑梗死患者血清糖化血红蛋白(glycosylated hemoglobin,HbA1c)、同型半胱氨酸(homocysteine,Hcy)、尿酸(uricacid,UA)水平对其预后的预测价值。方法回顾性连续纳入2017-06—2018-05我院收治入院的急性脑梗死患者132例(要求年龄≥55岁),其中男87例,女47例。根据90d改良Rankin量表(mRS)评分标准将患者分为预后良好组74例和预后不良组58例,记录患者年龄、性别、既往病史、美国国立卫生研究院卒中量表(NIHSS)评分、血清HbA1c、Hcy、UA等临床资料,采用单因素分析2组患者上述各因素间差异,采用Logistics回归分析老年急性脑梗死预后不良的独立影响因素,采用受试者工作特征(ROC)曲线评价患者入院时血清HbA1c、Hcy水平对老年急性脑梗死患者预后不良的预测价值。结果与预后良好组相比,预后不良组患者心房颤动病史、入院时NIHSS评分、血清HbA1c、Hcy、部分活化凝血酶原(APTT)、大面积脑梗死均较高,2组间差异具有统计学意义(P<0.05)。通过多因素Logistics回归分析结果显示,老年急性脑梗死患者心房颤动病史、入院时NIHSS评分、血清HbA1c、Hcy、大面积脑梗死指标是预后不良的独立危险因素(OR值分别为0.231、1.090、1.754、1.050、0.089,95%CI分别为0.069~0.769、1.003~1.269、1.242~2.478、1.007~1.095、0.031~0.256,均P<0.05)。入院时血清HbA1c、Hcy水平对老年急性脑梗死患者预后不良的诊断界值分别为7.45%、15.43 mg/L,灵敏度分别为56.39%、61.43%,特异度分别为78.25%、64.26%。结论老年急性脑梗死患者入院时血清HbA1c、Hcy水平增高对评估患者预后不良具有一定的参考价值,血清UA价值有待进一步研究。

Objective To explore the prognostic value of serum glycosylated hemoglobin （HbA1c）,homocysteine （Hcy）, and uricacid （UA） in elderly patients with acute cerebral infarction. Methods A retrospective study of 132 patients with acutecer ebral infarction admitted to the first affiliated hospital of anhui medical university from June 2017 to May 2018 （required age to be over 55 years old） ,there were 87 males and 47 females. According to the 90 days modified Rankin scale （mRS） score standard, there were 74 patients with good prognosis and 58 patients with poor prognosis. The patient＇s age, gender, past history,the national institutes of health stroke scale （NIHSS） score,serum HbAlc,Hcy,UA and other clinical data were recorded. Using single factor to analysis the difference between two groups of patients with the above factors, Logistics regression analysis independent influence factors of prognosis of elderly acute cerebral infarction, and adopt the receiver operating characteristic （ROC） curve evaluation the prognosis prediction value on admission in patients with serum HbA1c, Hcy levels. Results Compared with good prognosis group ,history of atrial fibrillation,NIHSS score on admission,Serum HbAlc, Hcy,part of the activation of prothrombin （APTT） , large area cerebral infarction were higher in patients with poor prognosis group, the differences between the two groups have sta tistical significance（P 〈0.05）. Multi factor Logistics regression analysis results show that the history of atrial fibrillation, NIHSS score on admission, serum levels of HbAlc, Hcy,large area cerebral infarction index are independent risk factors of poor prognosis in elderly patients with acute cerebral infarction（The OR value is 0. 231,1. 090,1. 754,1. 050,0. 089 respectively,95% CI value is 0. 06940. 769,1. 00341. 269,1. 24242. 478,1. 00741. 095,0. 03140. 256 respectively,P 〈0.05）. The diagnostic value of serumHbA1lc and Hey level for the elderly patients with acute cerebral infarction was 7.45% and 15.43 mg/L respectively. The sensitiv ity was 56.39% , 61.43% , and the specificity was 78.25% and 64.26% respectively. Conclusion The higher level of serum HbA1c and Hcy in elderly patients with acute cerebral infarction has a certain reference value in evaluating the prognosis of pa tients,and the value of serum UA needs to be further studied.