血浆Dickkopf-1预测急性缺血性卒中患者的早期神经功能恶化和转归

Plasma Dickkopf-1 predicts early neurological deterioration and outcome in patients with acute ischemic stroke

目的探讨血浆Dickkopf-1与急性缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)和转归的关系。方法连续纳入2020年1月至2020年12月在南京江北医院神经内科住院的首发急性缺血性卒中患者。所有患者均在发病后24 h内入院。END定义为入院后7 d内任意一次美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线增加≥2分或运动项评分增加≥1分。转归不良定义为发病后90 d时改良Rankin量表评分>2分。应用多变量logistic回归分析确定Dickkopf-1与END和转归的独立相关性。应用受试者工作特征(receiver operating characteristic,ROC)曲线评估血浆Dickkopf-1对END和转归不良的预测价值。结果共纳入176例患者,男性92例(52.3%),年龄(66.7±9.6)岁。中位Dickkopf-1为4.30μg/L,52例(29.5%)发生END,81例(46.0%)转归不良。多变量logistic回归分析表明,Dickkopf-1较高是END[优势比(odds ratio,OR)1.696,95%置信区间(confidence interval,CI)1.223~2.351;P=0.002]和转归不良(OR 1.566,95%CI 1.156~2.121;P=0.004)的独立预测因素。ROC曲线分析显示,血浆Dickkopf-1对END具有良好的预测价值,其曲线下面积为0.717(95%CI 0.634~0.801);最佳截断值为4.40μg/L,对应的预测敏感性和特异性分别为71.2%和60.5%。Dickkopf-1对转归不良也具有较好的预测价值,其曲线下面积为0.701(95%CI 0.624~0.778);最佳截断值为4.25μg/L,对应的预测敏感性和特异性分别为65.4%和61.1%。结论血浆Dickkopf-1对急性缺血性卒中患者的END和转归不良均具有较好的预测价值。

Objective To investigate the relationship between plasma Dickkopf-1 and early neurological deterioration(END)and outcome in patients with acute ischemic stroke.Methods From January 2020 to December 2020,consecutive patients with first-ever ischemic stroke form the Department of Neurology,Nanjing Jiangbei Hospital were included.All patients were hospitalized within 24 h after onset.END was defined as the National Institutes of Health Stroke Scale(NIHSS)score within 7 d after admission increased by≥2 or motor function score increased by≥1 compared with the baseline.Poor outcome was defined as the modified Rankin Scale score>2 at 90 d after onset.Multivariate logistic regression analysis was used to determine the independent correlation between plasma Dickkopf-1 and END and outcome.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of plasma Dickkopf-1 for END and poor outcome.Results A total of 176 patients were enrolled,including 92 males(52.3%),aged 66.7±9.6 years.The median Dickkopf-1 was 4.30μg/L,52 patients(29.5%)developed END,and 81(46.0%)had poor outcome.Multivariate logistic regression analysis showed that the higher Dickkopf-1 was an independent predictor of END(odds ratio[OR]1.696,95%confidence interval[CI]1.223-2.351;P=0.002)and poor outcome(OR 1.566,95%CI 1.156-2.121;P=0.004).ROC curve analysis showed that plasma Dickkopf-1 had good predictive value for END,and its area under the curve was 0.717(95%CI 0.634-0.801);the optimal cut-off value was 4.40μg/L,and the corresponding predictive sensitivity and specificity were 71.2%and 60.5%,respectively.Dickkopf-1 also had good predictive value for poor outcome,and its area under the curve was 0.701(95%CI 0.624-0.778);the optimal cut-off value was 4.25μg/L,and the corresponding predictive sensitivity and specificity were 65.4%and 61.1%,respectively.Conclusion Plasma Dickkopf-1 has good predictive value for END and poor outcome in patients with acute ischemic stroke.