血清CXCL12预测急性缺血性卒中患者静脉溶栓治疗后转归

Serum CXCL12 predicts the outcomes after intravenous thrombolytic therapy in patients with acute ischemic stroke

目的:探讨血清CXCL12与急性缺血性卒中患者静脉溶栓治疗后转归的相关性。方法:回顾性连续纳入2020年1月1日至2021年8月31日在苏州大学附属第一医院神经内科接受静脉溶栓治疗的急性缺血性卒中患者。在发病24 h内采用酶联免疫吸附法测定血清CXCL12。早期神经功能无改善定义为溶栓后24 h美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线降低<4分。在发病后90 d时采用改良Rankin量表评估临床转归,>2分定义为转归不良。应用多变量logistic回归分析评估血清CXCL12与静脉溶栓后转归的相关性,并通过受试者工作特征(receiver operating characteristic,ROC)曲线分析血清CXCL12对早期神经功能无改善以及短期转归不良的预测价值。结果:共纳入66例患者,血清CXCL12为(15.72±6.52)μg/L。27例(40.9%)患者转归不良,34(51.5%)患者早期神经功能无改善。多变量logistic回归分析显示,血清CXCL12较高是转归不良[优势比(odds ratio,OR)1.245,95%置信区间(confidence interval,CI)1.093~1.419;P=0.001]和早期神经功能无改善(OR 1.250,95%CI 1.100~1.420;P=0.001)的独立预测因素。ROC曲线分析显示,血清CXCL12预测转归不良的曲线下面积为0.793(95%CI 0.679~0.908),最佳截断值为15.38μg/L,对应的敏感性和特异性分别为81.5%和76.9%;预测早期神经功能无改善的曲线下面积为0.849(95%CI 0.748~0.951),最佳截断值为15.68μg/L,对应的敏感性和特异性分别为76.5%和87.5%。结论:血清CXCL12对急性缺血性卒中患者静脉溶栓治疗后转归具有较好的预测价值。

Objective:To investigate the correlation between serum CXCL12 and the outcomes after intravenous thrombolytic therapy in patients with acute ischemic stroke.Methods:Consecutve patients with acute ischemic stroke treated with intravenous thrombolytic therapy in the Department of Neurology,the First Affiliated Hospital of Soochow University from January 1,2020 to August 31,2021 were enrolled retrospectively.Serum CXCL12 was measured by enzyme-linked immunosorbent assay within 24 h of onset.No improvement in early neurological function was defined as the National Institutes of Health Stroke Scale(NIHSS)24 h after thrombolysis decreased by<4 compared with the baseline.The clinical outcome was evaluated by the modified Rankin Scale at 90 d after onset,and>2 were defined as a poor outcome.Multivariate logistic regression analysis was used to evaluate the correlation between serum CXCL12 and the outcome after intravenous thrombolysis,and the predictive value of serum CXCL12 for no improvement of early neurological function and poor short-term outcome was analyzed by the receiver operating characteristic(ROC)curve.Results:A total of 66 patients were enrolled,and the serum CXCL12 was 15.72±6.52 g/L.Twenty-seven patients(40.9%)had poor outcomes,and 34(51.5%)had no improvement in early neurological function.Multivariate logistic regression analysis showed that higher serum CXCL12 was an independent predictor of poor outcome(odds ratio[OR]1.245,95%confidence interval[CI]1.093-1.419;P=0.001)and no improvement in early neurological function(OR 1.250,95%CI 1.100-1.420;P=0.001).ROC curve analysis showed that the area under the curve of serum CXCL12 for predicting poor outcome was 0.793(95%CI 0.679-0.908),the best cut-off value was 15.38μg/L,and the corresponding sensitivity and specificity were 81.5%and 76.9%,respectively.The area under the curve of serum CXCL12 for predicting no improvement of early neurological function was 0.849(95%CI 0.748-0.951),and the best cut-off value was 15.68μg/L,and the corresponding sensitivity and specificity were 76.5%and 87.5%,respectively.Conclusion:Serum CXCL12 had a better predictive value for the outcomes of patients with acute ischemic stroke after intravenous thrombolytic therapy.