经颅多普勒超声联合GFAP对急性脑梗死患者预后的评估价值

Predictive value of transcranial Doppler ultrasound combined with GFAP in prognosis of patients with acute cerebralinfarction

目的探讨经颅多普勒超声(TCD)联合胶质纤维酸性蛋白(GFAP)对急性脑梗死(ACI)患者预后的评估价值。方法 选取2019年8月至2021年7月东南大学医学院附属南京同仁医院收治的180例ACI患者,根据神经功能缺损程度分为轻度组、中度组和重度组,根据治疗半年后改良Rankin量表(mRS)分为预后良好组和预后不良组。应用TCD测定椎-基底动脉平均血流速度(Vm)、搏动指数(PI)、阻力指数(RI),检测患者血清GFAP水平。分析TCD参数及血清GFAP水平与ACI患者预后的关系。结果 重度组和中度组PI、RI值及血清GFAP水平明显高于轻度组,重度组又高于中度组(P<0.05);重度组和中度组Vm显著低于轻度组,重度组又低于中度组(P<0.05)。ACI患者NIHSS评分与PI、RI及血清GFAP水平呈显著正相关,与Vm呈负相关(P<0.05)。预后不良组患者PI、RI及血清GFAP水平高于预后良好组,Vm低于预后良好组(P<0.05)。Logistic回归分析显示,椎-基底动脉Vm、PI、RI及血清GFAP水平均是影响ACI患者预后的重要因素(P<0.05)。TCD参数(Vm、PI、RI)联合GFAP预测ACI预后不良的曲线下面积(ROC)为0.906,灵敏度为87.9%,特异度为86.4%。结论 脑血流动力学状况及血清GFAP水平与ACI患者预后密切相关,TCD联合血清GFAP检测可作为早期评估ACI患者预后的参考依据。

Objective To investigate the predictive value of transcranial doppler ultrasound(TCD)combined with glial fibrillary acidic protein(GFAP)in prognosis of patients with acute cerebral infarction(ACI).Methods A total of 180 patients with ACI admitted to Nanjing Tongren Hospital Affiliated Hospital of Medical College of Southeast University from August 2019 to July 2021 were selected and divided into mild group,moderate group and severe group according to the degree of neurological defect,and divided into good prognosis group and poor prognosis group according to modified Rankin scale(mRS)after half a year of treatment.The mean blood flow velocity(Vm),pulsatile index(PI)and resistance index(RI)were measured by TCD.The level of serum GFAP was detected.The relationship between serum GFAP level and TCD parameters and the prognosis of patients with ACI was analyzed.Results The,PI,RI and the levels of serum GFAP in severe group and moderate group were significantly higher than those in mild group,and those in severe group were significantly higher than those in moderate group(P<0.05).The Vm of severe group and moderate group was significantly lower than that of mild group,and the Vm of severe group was lower than that of moderate group(P<0.05).NIHSS score in ACI patients was positively correlated with PI,RI,the level of GFAP,and was negatively correlated with Vm(P<0.05).The PI,RI and serum GFAP level in the poor prognosis group were higher than those in the good prognosis group,and Vm was lower than that in the good prognosis group(P<0.05).Logistic regression analysis showed that the Vm,PI,RI and serum GFAP level were important factors affecting the prognosis of patients with ACI(P<0.05).The area under the curve(ROC)of TCD parameters(Vm,PI,RI)combined with GFAP in predicting poor prognosis of ACI was O.906,with the sensitivity of 87.9%and the specificity of 86.4%.Conclusion The cerebral hemodynamic status and serum GFAP level are closely related to the prognosis of ACI patients.TCD combined with GFAP can be used as a reference for early assessment of the prognosis of ACI patients.