血清Hcy、Lp-PLA_(2)、CRP及血栓弹力图在缺血性脑卒中患者中的表达及对预后的预测价值

Expression of Serum Hcy,Lp-PLA_(2),CRP and Thromboelastography in Patients with Ischemic Stroke and Predictive Value for Prognosis

目的探讨血清同型半胱氨酸(Hcy)、脂蛋白相关磷脂酶A 2(Lp-PLA_(2))、C反应蛋白(CRP)及血栓弹力图在缺血性脑卒中患者中的表达,并分析其对预后的预测价值。方法选取2021年2月至2022年12月南阳市中心医院诊治的92例缺血性脑卒中患者作为研究组,根据美国国立卫生研究院卒中量表评分(NIHSS)分为轻度组(NIHSS≤4分,45例)和中重度组(NIHSS>4分,47例)。随访30 d,根据改良Rankin量表(mRS)将患者分为预后良好组(mRS<2分,64例)和预后不良组(mRS≥2分,28例),并选取同期健康体检者92例纳入对照组,比较各组血清Hcy、Lp-PLA_(2)、CRP及血栓弹力图。结果研究组Hcy、Lp-PLA_(2)、CRP、血栓最大振幅(MA)、血凝块力学强度(G)高于对照组(P<0.05)。轻度组血凝块形成时间(K)、凝血反应时间(R)长于中重度组(P<0.05),轻度组Hcy、Lp-PLA_(2)、CRP、纤溶参数(LY30)低于中重度组(P<0.05)。预后良好组Hcy、Lp-PLA_(2)、CRP低于预后不良组(P<0.05),预后良好组K高于预后不良组(P<0.05)。受试者工作特征(ROC)曲线分析显示,K、Hcy、Lp-PLA_(2)、CRP及联合预测缺血性卒中患者预后不良的曲线下面积(AUC)分别为0.644、0.789、0.743、0.754、0.953,敏感度分别为100.0%、85.7%、89.3%、85.7%、96.4%,特异度分别为20.3%、60.9%、51.6%、53.1%、81.2%。结论缺血性脑卒中患者血清Hcy、Lp-PLA_(2)、CRP和血栓弹力图G、MA升高,且症状越严重,血清Hcy、Lp-PLA_(2)、CRP和血栓弹力图LY30越高,血栓弹力图K、R越低,血清Hcy、Lp-PLA_(2)、CRP及血栓弹力图K联合对缺血性脑卒中患者预后不良具有较高的预测价值。

Objective To explore the expression of serum homocysteine(Hcy),lipoprotein associated phospholipase A 2(Lp-PLA_(2)),C-reactive protein(CRP)and thromboelastography in patients with ischemic stroke,and analyze the predictive value for prognosis.Methods A total of 92 patients with ischemic stroke who were diagnosed and treated in Nanyang Central Hospital from February 2021 to December 2022 were included in study group.According to the National Institutes of Health Stroke Scale(NIHSS)score,patients were divided into mild group(NIHSS≤4 points,45 cases)and moderate to severe group(NIHSS>4 points,47 cases).After a follow-up of 30 days,patients were divided into good prognosis group(mRS<2 points,64 cases)and poor prognosis group(mRS≥2 points,28 cases)based on the modified Rankin scale(mRS).And 92 healthy individuals who underwent physical examination during the same period were included in the control group,and the serum Hcy,Lp-PLA_(2),CRP and thromboelastography were compared between groups.Results The Hcy,Lp PLA_(2),CRP,maximum amplitude of thrombus(MA)and mechanical strength of blood clots(G)levels in the study group were higher than those in the control group(P<0.05).The blood clot formation time(K)and coagulation reaction time(R)levels in the mild group were longer than those in the moderate to severe group(P<0.05),while the Hcy,Lp-PLA_(2),CRP and clot lysis at 30 minutes(LY30)levels in the mild group were lower than those in the moderate to severe group(P<0.05).The Hcy,Lp-PLA_(2)and CRP levels in the good prognosis group were lower than those in the poor prognosis group(P<0.05),while K level in the good prognosis group was higher than that in the poor prognosis group(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of K,Hcy,Lp-PLA_(2),CRP and combined predicting poor prognosis in ischemic stroke patients were 0.644,0.789,0.743,0.754 and 0.953,respectively.The sensitivity were 100.0%,85.7%,89.3%,85.7%,96.4%,respectively,and the specificity were 20.3%,60.9%,51.6%,53.1%and 81.2%,respectively.Conclusion The serum Hcy,Lp-PLA_(2),CRP and thromboelastogram G and MA in patients with ischemic stroke increase,and the more severe the symptoms,the higher the serum Hcy,Lp-PLA_(2),CRP and thromboelastogram LY30,and the lower the thromboelastogram K and R.The combination of serum Hcy,Lp-PLA_(2),CRP and thromboelastogram K has high predictive value for poor prognosis in patients with ischemic stroke.