高敏肌钙蛋白T对静脉溶栓后急性缺血性脑卒中患者预后判断的临床价值

Prognostic clinical value of elevated high-sensitivity cardiac troponin T levels inpatients with acute ischemic stroke treated with intravenous thrombolytic therapy

目的:研究高敏肌钙蛋白T(hs-cTnT)升高对急性缺血性脑卒中(acute ischemic stroke,AIS)行静脉溶栓患者的临床预后和病死率的影响,并探讨影响hs-cTnT升高的因素。方法:回顾性分析本院262例患者的临床资料,分为hs-cTnT升高组(70例)和hs-cTnT正常组(192例),预后不佳组(94例)和预后良好组(168例),死亡组(24例)和存活组(238例),分别进行组间比较、单因素和多因素回归分析。结果:多因素回归分析结果显示,高龄(OR=1.062,95%CI:1.029~1.097,P<0.001)、男性(OR=4.35,95%CI:1.982~9.545,P<0.001)、入院时美国国立卫生研究院卒中量表(NIHSS)评分(OR=1.062,95%CI:1.019~1.106,P=0.004)是hs-cTnT升高的危险因素。高龄(OR=1.031,95%CI:1.003~1.059,P=0.028)、入院时NIHSS评分(OR=1.086,95%CI:1.042~1.131,P<0.001)是AIS患者术后90 d预后不佳的危险因素。hs-cTnT升高(OR=5.31,95%CI:1.025~27.517,P=0.047)、入院NIHSS评分(OR=1.126,95%CI:1.057~1.200,P<0.001)、高血压(OR=4.254,95%CI:1.387~13.046,P=0.011)是AIS患者术后90 d死亡的危险因素。结论:高龄、男性、入院时NIHSS评分高的AIS患者hs-cTnT检测水平更高,因而hs-cTnT可作为潜在的标志物来预测AIS患者静脉溶栓后的90 d病死率。

Objective:This study aims to study the effect of elevated hs-cTnT on clinical outcome and mortality in AIS patients who were under intravenous thrombolytic therapy after 90 days and explore the factors affecting hs-cTnT elevation.Methods:The clinical data of 262 patients were collected and retrospectively analyzed.They were divided into hs-cTnT elevation group(n=70)and hs-cTnT normal group(n=192),poor outcome group(n=94)and good outcome group(n=168),mortality group(n=24)and survival group(n=238).Groups comparison,univariate regression analysis,multivariate regression analysis were performed.Results:Multivariate regression analysis results showed that,factors associated with hs-cTnT elevation were elderly(OR=1.062,95%CI:1.029~1.097,P<0.001),male patients(OR=4.35,95%CI:1.982~9.545,P<0.001)and admission NIHSS score(OR=1.062,95%CI:1.019~1.106,P=0.004).Factors associated with poor outcome in AIS patients who were under intravenous thrombolytic therapy after 90 d were elderly(OR=1.031,95%CI:1.003~1.059,P=0.028)and admission NIHSS score(OR=1.086,95%CI:1.042~1.131,P<0.001).Factors associated with mortality in AIS patients who were under intravenous thrombolytic therapy after 90 d were hs-cTnT elevation(OR=5.31,95%CI:1.025~27.517,P=0.047),admission NIHSS score(OR=1.126,95%CI:1.057~1.200,P<0.001)and high blood pressure(OR=4.254,95%CI:1.387~13.046,P=0.011).Conclusion:Elderly,male patients in AIS with high NIHSS scores at admission had higher levels of hs-cTnT.Thus hs-cTnT could be used as a possible marker to predict 90 d mortality after intravenous thrombolysis in AIS patients.