急性脑梗死静脉溶栓患者RBP、Hcy、Lpa与NIHSS评分关系及预测血管再通的效能

Relationship between RBP,Hcy,LPA and NIHSS score in patients with acute cerebral infarction undergoing intravenous thrombolysis

目的探讨急性脑梗死静脉溶栓患者视黄醇结合蛋白(RBP)、同型半胱氨酸(Hcy)、脂蛋白a(Lpa)与美国国立卫生研究院卒中量表(NIHSS)评分关系及联合预测血管再通的效能。方法选取2019年1月至2020年12月淮南新华医疗集团新华医院收治的84例具有静脉溶栓指征的急性脑梗死患者进行研究,均行阿替普酶静脉溶栓,根据溶栓后血管再通情况分为非再通组(n=21)、再通组(n=63),比较两组基线资料、RBP、Hcy、Lpa水平,应用Pearson及偏相关性分析各指标与NIHSS评分关系,应用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析各指标预测血管非再通的效能。结果非再通组脑卒中史与再通组比较,差异有统计学意义(P<0.05),非再通组NIHSS评分、RBP、Hcy、Lpa高于再通组,差异有统计学意义(P<0.05);RBP、Hcy、Lpa与NIHSS评分呈正相关(P<0.05);偏相关性分析显示,将脑卒中史控制后,RBP、Hcy、Lpa仍与NIHSS评分相关(P<0.05);RBP、Hcy、Lpa预测血管再通的AUC分别为0.858、0.897、0.751,RBP、Hcy联合Lpa预测血管非再通的AUC为0.912(P<0.05)。结论RBP、Hcy、Lpa与急性脑梗死静脉溶栓患者神经缺损程度和静脉溶栓后血管再通情况有关,可作为预测血管再通情况的生物标志物,为临床评估病情、治疗决策等提供参考。

Objective To explore the relationship between retinol binding protein(RBP),homocysteine(Hcy),lipoprotein a(LPA)and National Institutes of Health Stroke Scale(NIHSS)score in patients with acute cerebral infarction undergoing intravenous thrombolysis and the efficacy of combined prediction of vascular recanalization.Methods 84 cases of acute cerebral infarction patients with indications of intravenous thrombolysis in Huainan Xinhua Medical Group Xinhua Hospital from January 2019 to December 2020 were selected for the study.All patients underwent intravenous thrombolysis with altepl.According to the recanalization after thrombolysis,they were divided into the non-recanalization group(n=21)and the recanalization group(n=63).The baseline data,RBP,Hcy and LPA levels of the two groups were compared.Pearson and partial correlation were used to analyze the relationship between each indicator and NIHSS score.Receiver operating characteristic curve(ROC)and area under ROC(AUC)were used to analyze the effectiveness of each indicator in predicting the effectiveness of non-recanalization.Results There was a statistically significant difference between the history of stroke in the non-recanalization group and the recanalization group(P<0.05).The NIHSS score,RBP,Hcy,and Lpa of the non-recanalization group were higher than those of the recanalization group(P<0.05).RBP,Hcy,Lpa and NIHSS score were positivelycorrelated(P<0.05).Partial correlation analysis showed that after controlling for stroke history,RBP,Hcy,and Lpa were still correlated with NIHSS score(P<0.05).RBP,Hcy,and Lpa predicted the AUC of recanalization were 0.858,0.897,0.751,respectively.The predicted AUC of non-recanalized blood vessels by Hcy combined with Lpa was 0.912.Conclusion RBP,Hcy,and Lpa are related to the degree of nerve defect and vascular recanalization after intravenous thrombolysis in patients with acute cerebral infarction.They can be used as biomarkers to predict vascular recanalization and provide references for clinical evaluation of the condition and treatment decisions.