血清碱性磷酸酶与青年缺血性卒中患者早期临床转归的相关性

Correlation between serum alkaline phosphatase level and early functional outcomes in young patients with acute ischemic stroke

目的探讨血清碱性磷酸酶(alkaline phosphatase,ALP)与青年急性缺血性卒中早期临床转归的相关性。方法连续纳入2017年1月至2018年12月期间在阜阳市人民医院神经内科住院的青年(18~45岁)急性缺血性卒中患者,根据出院时或住院第14天时改良Rankin量表评分分为转归不良组(>2分)和转归良好组(0~2分),比较2组患者的人口统计学和基线临床资料。应用多变量logistic回归分析确定血清ALP水平与转归的独立相关性。采用受试者工作特征(receiver operating characteristic,ROC)曲线评价基线血清ALP水平对转归不良的预测价值。结果共纳入急性青年缺血性卒中患者200例,转归良好组138例(69.0%),转归不良组62例(31.0%)。单变量分析显示,转归不良组血清ALP水平[(87.72±25.60)U/L对(81.70±22.95)U/L;t=-4.464,P<0.001]和基线NIHSS评分[中位数和四分位数间距:9(8~12)分对2(1~4)分;Z=-10.540,P<0.001]显著高于转归良好组。多变量logistic回归分析显示,高血清ALP水平(优势比1.030,95%可信区间1.001~1.060;P=0.040)和高基线NIHSS评分(优势比2.387,95%可信区间1.799~3.142;P<0.001)是早期转归不良的独立危险因素。ROC曲线分析显示,基线血清ALP水平预测转归不良的最佳截断值为86.25 U/L,其敏感性和特异性分别为53.2%和79.7%。结论高血清ALP水平与青年急性缺血性卒中早期转归不良独立相关,基线血清ALP水平对转归不良有一定的预测价值。

Objective To investigate the correlation between serum alkaline phosphatase(ALP)level and early functional outcomes in young patients with acute ischemic stroke.Methods From January 2017 to December 2018,consecutive young patients(18-45 years old)with acute ischemic stroke admitted to the Department of Neurology,Fuyang People's Hospital were enrolled.According to the modified Rankin Scale score at discharge or on the 14th day of hospitalization(whichever occurs first),the patients were divided into poor outcome group(>2)and good outcome group(0-2).Multivariate logistic regression analysis was used to determine the independent correlation between the serum ALP level and outcomes.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of baseline serum ALP level for poor outcomes.Results A total of 200 young patients with acute ischemic stroke were enrolled,and 138(69.0%)in the good outcome group and 62(31.0%)in the poor outcome group.Univariate analysis showed that the serum ALP level(87.72±25.60 U/L vs.81.70±22.95 U/L;t=-4.464,P<0.001)and baseline National Institutes of Health Stroke Scale(NIHSS)score(median and interquartile range:9[8-12]vs.2[1-4];Z=-10.540,P<0.001)in the poor outcome group were significantly higher than those in the good outcome group.Multivariate logistic regression analysis showed that high serum ALP levels(odds ratio 1.030,95%confidence interval 1.001-1.060;P=0.040)and high baseline NIHSS score(odds ratio 2.387,95%confidence interval 1.799-3.142;P<0.001)were the independent risk factors for early poor outcomes.ROC curve analysis showed that the optimal cut-off value of the baseline serum ALP level predicting poor outcome was 86.25 U/L,and its sensitivity and specificity were 53.2%and 79.7%,respectively.Conclusions High serum ALP level is independently associated with poor early outcomes in young patients with acute ischemic stroke.Baseline serum ALP level has certain predictive value for poor outcomes.