血清L-Arg,ADMA水平与急性脑梗死患者静脉溶栓疗效的相关性分析

The correlative analysis between serum L-Arg, ADMA levels and the effect of intravenous thrombolysis in patients with acute cerebral infarction

目的探究血清L-精氨酸(L-Arg)、非对称性二甲基精氨酸(ADMA)水平与急性脑梗死患者行重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓疗效的相关性。方法选取2017年10月-2019年10月在本院神经内科接受rt-PA静脉溶栓治疗的急性脑梗死患者80例为研究对象,随访90 d,根据随访的mRS评分分为预后良好(mRS评分≤2分)组53例和预后不良(mRS评分>2分)组27例;采用酶联免疫吸附(ELISA)法检测各研究对象rt-PA静脉溶栓后24h内血清中L-Arg,ADMA的水平;在患者rt-PA静脉溶栓后24 h内及治疗5天后行美国国立卫生研究院卒中量表(NIHSS)测评,比较患者2个时间点NIHSS评分差(△NIHSS分);Pearson法分析L-Arg与ADMA水平、△NIHSS水平的相关性;采用COX法分析影响急性脑梗死患者静脉溶栓后预后不良的危险因素。结果与预后良好组比较,预后不良组患者血清L-Arg水平、△NIHSS评分较低(P<0.05),血清ADMA水平较高(P<0.05);Pearson分析显示,L-Arg与ADMA水平呈负相关(r=-0.758,P<0.05);与△NIHSS正相关(r=0.668,P<0.05),ADMA水平与△NIHSS呈负相关(r=-0.674,P<0.05);多因素COX分析显示,低水平L-Arg、高水平ADMA、低△NIHSS评分是影响急性脑梗死患者rt-PA静脉溶栓后预后不良的独立危险因素(P<0.05)。结论急性脑梗死患者静脉溶栓的疗效可能与血清L-Arg,ADMA水平相关,L-Arg水平降低、ADMA水平升高可能提示急性脑梗死患者静脉溶栓后预后不良的发生。

Objective To explore the correlation between serum L-arginine(L-Arg), asymmetric dimethylarginine(ADMA) levels and the therapeutic effect of intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA) in patients with acute cerebral infarction. Methods From October 2017 to October 2019, 80 patients with acute cerebral infarction who received rt-PA intravenous thrombolysis in the department of neurology of our hospital were selected as the study objects, and the patients were followed up for 90 days, then according to mRS of the follow-up, they were divided into good prognosis(mRS≤2 points) group(n=53)and poor prognosis(mRS>2 points) group(n=27). Within 24 hours after rt-PA intravenous thrombolysis, serum L-Arg and ADMA levels were detected by enzyme-linked immunosorbent assay(ELISA). Within 24 hours after rt-PA intravenous thrombolysis and after 5 days of treatment, National institutes of health stroke scale(NIHSS) was carried out, and the △ NIHSS score was compared. Pearson method was used to analyze the correlation between L-Arg and ADMA levels. COX method was used to analyze the risk factors of poor prognosis in patients with acute cerebral infarction after intravenous thrombolysis. Results Compared with good prognosis group, serum L-Arg level and △ NIHSS score in the poor prognosis group were lower(P<0.05), while serum ADMA level was higher(P<0.05). Pearson analysis showed that L-Arg level was negatively correlated with ADMA level(r=-0.758, P<0.05), and positively correlated with △ NIHSS score(r=0.668, P<0.05), while ADMA level was negatively correlated with △ NIHSS score(r=-0.674, P<0.05). Multivariate COX analysis showed that low-level L-Arg, high-level ADMA and low △ NIHSS score were independent risk factors for poor prognosis of patients with acute cerebral infarction after rt-PA intravenous thrombolysis(P<0.05). Conclusion The therapeutic effect of intravenous thrombolysis for patients with acute cerebral infarction might be related to serum L-Arg and ADMA levels, The decrease of L-Arg level and the increase of ADMA level might indicate the poor prognosis of patients with acute cerebral infarction after intravenous thrombolysis.