血清ICAM-1、CRP及MCP-1水平与阿替普酶静脉溶栓脑卒中患者预后的关系

Relationship between serum levels of ICAM-1,CRP and MCP-1 and the prognosis of stroke patients undergoing intravenous thrombolysis with alteplase

目的 探究血清细胞间黏附分子-1(ICAM-1)、C反应蛋白(CRP)和单核细胞趋化蛋白-1(MCP-1)水平与阿替普酶静脉溶栓脑卒中患者预后的关系。方法 选取2018年3月—2021年3月在本院接受阿替普酶静脉溶栓治疗的急性缺血性脑卒中(AIS)患者127例,根据治疗后90 d的改良Rankin量表(mRS)评分结果将患者分为预后良好组(mRS≤2分,n=81)和预后不良组(mRS>2分,n=46)。比较两组患者一般临床资料和血清ICAM-1、CRP、MCP-1水平,Logistic回归分析法分析影响AIS患者预后的危险因素,受试者工作特征曲线(ROC)评估ICAM-1、CRP、MCP-1对AIS患者溶栓后90 d预后不良的预测价值。结果 预后不良组患者的冠心病、心房颤动发生率和美国国立卫生研究院卒中量表(NIHSS)评分均高于预后良好组(P<0.05),血清ICAM-1、CRP和MCP-1水平均高于预后良好组(P<0.05)。多因素Logistic回归分析结果显示,心房颤动、NIHSS评分、ICAM-1、CRP和MCP-1是影响AIS患者阿替普酶静脉溶栓后预后不良的独立危险因素(P<0.05)。ROC曲线分析结果显示,血清ICAM-1、CRP、MCP-1及其联合检测预测AIS患者溶栓后90 d预后不良的AUC值分别为0.763、0.729、0.808和0.844(P<0.05),联合检测预测患者预后不良的AUC值、灵敏度和特异度明显高于单一指标检测。结论 血清ICAM-1、CRP及MCP-1水平升高是影响阿替普酶静脉溶栓脑卒中患者预后不良的独立危险因素,三者联合检测可进一步提高临床预测患者的预后价值。

Objective To explore the relationship between serum levels of intercellular adhesion molecule-1(ICAM-1),C-reactive protein(CRP)and monocyte chemoattractant protein-1(MCP-1)and the prognosis of stroke patients undergoing intravenous thrombolysis with alteplase.Methods A total of 127 patients with acute ischemic stroke(AIS)who underwent intravenous thrombolysis with alteplase in the hospital from March 2018 to March 2021 were selected.According to the modified Rankin scale(mRS)score in 90 days after treatment,the patients enrolled were divided into good prognosis group(mRS score≤2,n=81)and poor prognosis group(mRS score>2,n=46).The general clinical data and serum levels of ICAM-1,CRP and MCP-1 of the two groups were compared.Logistic regression analysis was performed to screen the risk factors affecting the prognosis of patients with AIS.The predictive value of ICAM-1,CRP and MCP-1 for 90d poor prognosis of patients with AIS after thrombolysis was evaluating with the receiver operating characteristic(ROC)curve.Results The incidences of coronary heart disease and atrial fibrillation,and the National Institutes of Health Stroke Scale(NIHSS)scores in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Serum levels of ICAM-1,CRP and MCP-1 in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Multivariate logistic regression analysis showed that atrial fibrillation,NIHSS score,ICAM-1,CRP and MCP-1 were independent risk factors affecting the poor prognosis of patients with AIS after intravenous thrombolysis with alteplase(P<0.05).ROC curve analysis showed that the AUC values of serum ICAM-1,CRP,MCP-1 alone and in combination to predict 90d poor prognosis of patients with AIS after thrombolysis were 0.763,0.729,0.808 and 0.844,respectively(P<0.05).The AUC value,sensitivity and specificity of combined detection to predict poor prognosis were significantly higher than those of each index single detection.Conclusion Increased serum levels of ICAM-1,CRP and MCP-1 are independent risk factors for poor prognosis of stroke patients undergoing intravenous thrombolysis with alteplase.The above results indicate that the three indicators all have certain prognostic value,and combined detection of the three can improve the clinical predictive value.