血清NSE、IMA及LPA对急性脑梗死患者预后的评估价值

Predictive value of serum NSE, IMA and LPA on prognosis in patients with acute cerebral infarction

目的探讨血清神经元特异性烯醇化酶(NSE)、缺血修饰白蛋白(IMA)及溶血磷脂酸(LPA)对急性脑梗死(ACI)患者预后的评估价值。方法分析149例ACI患者临床资料,根据治疗后3个月患者改良Rankin评分(mRS)分为预后良好组(85例,mRS≤2分)和预后不良组(64例,mRS>2分)。对比两组临床资料,Logistic回归分析确定影响ACI患者预后的危险因素,分析血清NSE、IMA及LPA与美国国立卫生院卒中表(NIHSS)评分的相关性,绘制受试者工作特征曲线(ROC)曲线分析血NSE、IMA、LPA水平对ACI患者预后的预测价值。结果预后不良组患者后循环梗死发生率、入院NIHSS评分、发病至给药时间及血清NSE、IMA、LPA水平明显高于预后良好组(P<0.05)。Logistic回归分析显示,后循环梗死、入院NIHSS评分、发病至给药时间长及血清NSE、IMA、LPA水平升高是ACI患者预后不良的重要危险因素(P<0.05)。ACI患者血清NSE、IMA、LPA水平与NIHSS评分均呈显著正相关(P<0.05)。血清NSE、IMA及LPA评估ACI患者预后的ROC曲线下面积分别为0.806、0.803、0.819。结论血清NSE、IMA及LPA水平与ACI患者神经功能损伤情况密切相关,其水平升高预示患者预后不良,检测血清三项指标水平有助于判断ACI患者预后状况。

Objective To explore the predictive value of serum neuron-specific enolase(NSE),ischemic modified albumin(IMA)and lysophosphatidic acid(LPA)on prognosis in patients with acute cerebral infarction(ACI).Methods Clinical data of 149 patients with ACI were retrospectively analyzed.The patients were divided into good prognosis group(85 cases,mRS≤2)and bad prognosis group(64 cases,mRS>2)according to mddified Rankin scale(mRS)3 months after treatment.The clinical data of two groups were compared.Logistic regression analysis was performed to determine the risk factors affecting the prognosis of ACI,and the correlation between serum NSE,IMA and LPA and score of NIH stroke scale(NIHSS)was analyzed.Receiver operator characteristic(ROC)curve was drawn to analyze the predictive value of blood NSE,IMA and LPA levels on prognosis of ACI.Results The incidence of posterior circulation infarction,NIHSS score on admission,time between onset and administration and levels of serum NSE,IMA,LPA in bad prognosis group was significantly higher than that in good prognosis group(P<0.05).Logistic regression analysis showed that posterior circulation infarction,admission NIHSS score,long duration from onset to administration and elevated serum NSE,IMA,and LPA levels were important risk factors for poor prognosis in ACI(P<0.05).Serum NSE,IMA and LPA levels were positively correlated with NIHSS scores in ACI patients(P<0.05).The area under the ROC curve of serum NSE,IMA and LPA to assess the prognosis of ACI patients was 0.806,0.803 and 0.819,respectively.Conclusion Serum NSE,IMA and LPA levels are closely related to the neurological impairment of ACI patients,and their elevated levels indicate poor prognosis of patients.The detection of three serum indexes is helpful to determine the prognosis of ACI patients.