短暂性脑缺血发作后脑梗死发生影响因素及血栓调节蛋白对其预测价值研究

Influencing Factors of Cerebral Infarction after Transient Ischemic Attack and the Predictive Value of Thrombomodulin

背景短暂性脑缺血发作后易引发脑梗死,增加患者痛苦,因此寻找能准确预测短暂性脑缺血发作后脑梗死发生的生物学标志物极为重要,而临床目前相关研究较少。目的分析短暂性脑缺血发作后脑梗死发生的影响因素,并探讨血栓调节蛋白对其预测价值,以期为临床预测短暂性脑缺血发作后不良结局提供新的指标和依据。方法回顾性选取2014年7月—2018年2月威海市立医院收治的短暂性脑缺血发作患者140例为研究对象。根据患者是否进展为脑梗死,将其分为脑梗死组55例和非脑梗死组85例。收集并比较两组患者临床资料,包括性别、年龄、吸烟情况、高血压病史、糖尿病病史、高脂血症病史、首次发作至就诊时间、持续时间、发作次数、ABCD2评分及实验室指标(三酰甘油、低密度脂蛋白、高密度脂蛋白、血尿酸、空腹血糖、总胆固醇、血栓调节蛋白)。采用多因素Logistic回归分析探讨短暂性脑缺血发作后脑梗死发生的影响因素;采用受试者工作特征曲线(ROC曲线)分析ABCD2评分、血栓调节蛋白预测短暂性脑缺血发作后脑梗死发生的价值。结果脑梗死组高脂血症发生率、ABCD2评分、血尿酸、血栓调节蛋白高于非脑梗死组,首次发作至就诊时间、持续时间长于非脑梗死组,发作次数多于非脑梗死组,三酰甘油低于非脑梗死组(P<0.05)。多因素Logistic回归分析结果显示:高脂血症〔OR=3.149,95%CI(2.136,4.642)〕、首次发作至就诊时间〔OR=1.841,95%CI(1.217,2.783)〕、持续时间〔OR=2.161,95%CI(1.482,3.147)〕、发作次数〔OR=2.499,95%CI(1.589,3.930)〕、ABCD2评分〔OR=3.044,95%CI(2.114,4.382)〕、血栓调节蛋白〔OR=2.977,95%CI(1.923,4.609)〕是短暂性脑缺血发作后脑梗死发生的影响因素(P<0.05)。ABCD2评分预测短暂性脑缺血发作后脑梗死发生的ROC曲线下面积(AUC)为0.607〔95%CI(0.511,0.702)〕,截断值为3.4分,灵敏度和特异度分别为52.7%、71.8%;血栓调节蛋白预测短暂性脑缺血发作后脑梗死发生的AUC为0.782〔95%CI(0.700,0.863)〕,截断值为31.6 g/L,灵敏度和特异度分别为52.7%、96.5%。结论短暂性脑缺血发作后脑梗死发生的影响因素有高脂血症、首次发作至就诊时间、持续时间、发作次数、ABCD2评分、血栓调节蛋白;血栓调节蛋白可作为预测短暂性脑缺血发作后脑梗死发生的生物学标志物,有助于指导患者及时预防并治疗,降低脑梗死发生风险,具有较高的临床推广应用价值。

Background After transient ischemic attack,it is easy to cause cerebral infarction,thus increasing the pain of patients.Therefore,it is very important to find the markers that can accurately predict the occurrence of cerebral infarction after transient ischemic attack,but there are few clinical researches on this kind of markers.Objective To analyze the influencing factors of cerebral infarction after transient ischemic attack,and to explore the predictive value of thrombomodulin,in order to provide new indicators and basis for clinical prediction of adverse outcomes after transient ischemic attack.Methods 140 patients with transient cerebral ischemia admitted to Weihai Municipal Hospital from July 2014 to February 2018 were selected as the study objects.According to whether the patients developed into cerebral infarction or not,they were divided into cerebral infarction group(55 cases)and non cerebral infarction group(85 cases).The clinical data of the two groups was collected and compared,including gender,age,smoking,history of hypertension,history of diabetes,incidence of hyperlipidemia,visit time of first attack,duration,number of attacks,ABCD2 score and laboratory indexes(including triacylglycerol,LDL,HDL,SUA,FBG,total cholesterol,thrombomodulin).Multivariate Logistic regression analysis was used to explore the influencing factors of cerebral infarction after transient ischemic attack.The value of ABCD2 score and thrombomodulin in predicting the occurrence of cerebral infarction after transient ischemic attack were analyzed by using receiver operating characteristic(ROC)curve.Results The incidence of hyperlipidemia,ABCD2 score,SUA and thrombomodulin in the cerebral infarction group were higher than those in the non cerebral infarction group,the visit time of first attack and duration were longer than those in the non cerebral infarction group,and the attack times were more than those in the non cerebral infarction group,while the triacylglycerol was lower than that in the non cerebral infarction group(P<0.05).Multivariate Logistic regression analysis results showed that,hyperlipidemia〔OR=3.149,95%CI(2.136,4.642)〕,visit time of first attack〔OR=1.841,95%CI(1.217,2.783)〕,duration〔OR=2.161,95%CI(1.482,3.147)〕,attack times〔OR=2.499,95%CI(1.589,3.930)〕,ABCD2 score〔OR=3.044,95%CI(2.114,4.382)〕,thrombomodulin〔OR=2.977,95%CI(1.923,4.609)〕were the influencing factors of cerebral infarction after transient ischemic attack(P<0.05).The AUC of ABCD2 in predicting cerebral infarction after transient ischemic attack was 0.607〔95%CI(0.511,0.702)〕,the cutoff value was 3.4,the sensitivity and specificity were 52.7%and 71.8%,respectively.The AUC of thrombomodulin in predicting cerebral infarction after transient ischemic attack was 0.782〔95%CI(0.700,0.863)〕,the cutoff value was 31.6 g/L,the sensitivity and specificity were 52.7%and 96.5%,respectively.Conclusion The influencing factors of cerebral infarction after transient ischemic attack are hyperlipidemia,visit time of first attack,duration,attack times,ABCD2 score,thrombomodulin.Thrombomodulin can be used as a marker to predict the occurrence of cerebral infarction after transient ischemic attack,which is helpful to guide patients to prevent and treat in time,reduce the risk of cerebral infarction,and has high clinical application value.