超敏肌钙蛋白Ⅰ联合临床特征预测老年急性缺血性脑梗死患者短期预后的价值

Value of hs-TnⅠ Level combined with Clinical Characteristics in Predicting Short-term Prognosis of Elderly Patients with Acute Ischemic Cerebral Infarction

【目的】探讨超敏肌钙蛋白I(hs-TnI)水平联合临床特征预测老年急性缺血性脑梗死患者短期预后的价值。【方法】124例老年急性缺血性脑梗死患者,根据其预后不同分为预后不良组(n=40)和预后良好组(n=84)。比较两组患者一般临床资料、hs-TnI水平、美国国立卫生研究院卒中量表(NIHSS)评分等各项信息。将两组有差异的信息纳入Logistic模型,行量化赋值,以预后作为因变量,以空腹血糖>6.1 mmol/L、睡眠呼吸暂停综合征(SAS)、房颤、肺部感染占比、hs-TnI水平、NIHSS评分为自变量,分析影响老年急性缺血性脑梗死患者短期预后的危险因素。【结果】两组年龄、体重指数(BMI),性别、吸烟、饮酒、高血压、吞咽呛咳比例比较,差异无统计学意义(P>0.05);预后不良组空腹血糖>6.1 mmol/L、SAS、房颤、肺部感染占比显著高于预后良好组(P<0.05);预后不良组hs-TnI水平及NIHSS评分显著高于预后良好组(P<0.05)。hs-TnI预测老年急性缺血性脑梗死患者预后不良曲线下面积(AUC)为0.719,最佳界值为19.32 ng/mL,敏感度为70.00%,特异度为56.70%。多因素Logistic回归分析证实,血糖≥6.10 mmol/L、SAS、房颤、肺部感染、hs-TnI≥19.32 ng/mL、NIHSS评分≥15.25分是老年急性缺血性脑梗死患者预后不良的危险因素(P<0.05)。hs-TnI联合临床特征预测老年急性缺血性脑梗死患者预后不良的AUC为0.983,敏感度为95.00%,特异度为92.90%。【结论】老年急性缺血性脑梗死患者短期预后受到空腹血糖、SAS、房颤、肺部感染、hs-TnI水平、NIHSS评分影响,临床医师应给予密切关注,及时做出针对性的干预。

【Objective】To investigate the value of high-sensitivity troponin Ⅰ(hs-TnⅠ)level combined with clinical characteristics in predicting the short-term prognosis of elderly patients with acute ischemic cerebral infarction.【Methods】The clinical data of 124 elderly patients with acute ischemic cerebral infarction were analyzed retrospectively.They were divided into the poor prognosis group(n=40)and the good prognosis group(n=84).The information of clinical data[gender,age,body mass index(BMI),smoking,drinking,hypertension,blood glucose,sleep apnea syndrome,swallowing and choking cough,atrial fibrillation,pulmonary infection],hs-TnI,NIHSS score and large area infarction level were collected.The differential information between the two groups was incorporated into the logistic model for analysis.The prognosis was taken as the dependent variable and blood glucose,sleep apnea syndrome(SAS),atrial fibrillation,pulmonary infection,hs-TnI level,NIHSS score were taken as independent variables to clarify the risk factors affecting the short-term prognosis of elderly patients with acute ischemic cerebral infarction.【Results】There were no significant differences in terms of gender,age,BMI,smoking,drinking,hypertension,swallowing and choking cough between the two groups(P>0.05).The proportion of blood glucose>6.1 mmol/L,SAS,atrial fibrillation,pulmonary infection in the poor prognosis group was significantly higher than that in the good prognosis group(P<0.05).The hs-TnI and NIHSS score levels in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).The area under the poor prognosis curve(AUC)predicted by hs-TnⅠ was 0.719,the best boundary value was 19.32 ng/mL,the sensitivity was 70.00%,and the specificity was 56.70%.Multivariate logistic regression analysis confirmed that blood glucose≥6.10 mmol/L,SAS,atrial fibrillation,pulmonary infection,hs-TnI≥19.32 ng/mL,NIHSS score≥15.25 were the risk factors for poor prognosis in elderly patients with acute ischemic cerebral infarction(P<0.05).The AUC of hs-TnI combined with the poor clinical features was 0.983,with a sensitivity of 95.00%and a specificity of 92.90%.【Conclusion】The short-term prognosis of elderly patients with acute ischemic cerebral infarction is affected by blood glucose,SAS,atrial fibrillation,pulmonary infection,hs-TnI level,NIHSS score.Clinicians should pay close attention to them and make proper intervention in time.